Diabetes Medication Adherence Improvements Linked to Mobile Patient Portal Access

Patients with diabetes experienced improved medication adherence and glycemic control when they had computer patient portal access combined with mobile patient portal access, according to new study findings. Ilana Graetz, PhD, Rollins School of Public Health, Department of Health Policy and Management, Emory University, and colleagues published their study findings online in JAMA Network Open.  

“Patient portals that are tethered to a complete electronic health record (EHR) offer patients access to web-based tools for viewing laboratory test results, communicating with their health care team, and ordering prescription refills,” wrote Dr Graetz and colleagues.  

“Our prior research found that the addition of mobile portal access increases the frequency and timeliness of portal use.” 

In order to examine and understand the link between adding mobile patient portal access with diabetes medication adherence and glycemic levels among adults with diabetes, the study team conducted a retrospective cohort study. Included in the study were patients with diabetes treated at Kaiser Permanente Norther California from April 1, 2015 to December 31, 2017.  

The researchers categorized patient portal access status for each calendar month during the study period as: 

• never used;
• used from a computer only;
• used from a mobile device only; or
• used from both computer and mobile device. 

Further, medication adherence was measured by monthly percentage of days covered (PDC), and glycemic levels, measured by changes in glycated hemoglobin A_1c (HbA_1c) levels.

Based on the criteria, Dr Graetz and her team identified 111,463 study participants (mean [SD] age, 63.79 [12.93] years; 59 918 [53.76%] men).

According to the findings, they study authors found that patients using their portals via computer and mobile device increased over time from 38,371 patients (34.42%) in April 2015 to 57,920 patients (61.71%) in December 2017. Among study participants who never utilized portals in the past, an increase in PDC of 1.16 (95% CI, 0.63 to 1.70) percentage points and a change of −0.06 (95% CI, −0.08 to −0.03) percentage points in HbA_1c level was observed for those who added computer-only portal access. For those who added both mobile and computer portal access experienced an increase in PDC of 1.67 (95% CI, 1.10 to 2.23) percentage points and a change of −0.13 (95% CI, −0.16 to −0.10) percentage points in HbA_1c level. 

The study authors noted that patients with a higher baseline HbA_1c level (>8.0%) saw an increase in PDC of 5.09 (95% CI, 3.78 to 6.40) percentage points and a change of −0.19 (95% CI, −0.27 to −0.15) percentage points in HbA_1c level when they switched from no portal access to both computer and mobile access.  

“These findings suggest that providing patients with computer patient portal access and combining it with mobile patient portal access are associated with significantly improved diabetes medication adherence and glycemic control, with greater benefits among patients with more clinical need,” Dr Graetz and colleagues concluded.  

“Convenient access to portal self-management tools through a mobile device could significantly improve diabetes management.” 

—Julie Gould

Reference:

Graetz I, Huang J, Muelly ER, et al. Association of mobile patient portal access with diabetes medication adherence and glycemic levels among adults with diabetes [published online February 19, 2020]. JAMA Netw Open. 2020;3(2):e1921429. doi:10.1001/jamanetworkopen.2019.21429