February 28, 2020
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Mobile health portal access improves diabetes medication adherence

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Ilana Graetz

Adults with diabetes achieve more pronounced decreases in HbA1c and more regularly take their medications if they utilize a patient portal system with a mobile device as well as a computer, according to findings published in JAMA Network Open.

“Making patient portals easy to use from a smartphone, either with an app or mobile-optimized website, puts access to portal functions literally in the patient’s pocket and can improve diabetes management, including taking medication more consistently and lowering blood sugar levels,” Ilana Graetz, PhD, associate professor in the department of health policy and management at the Rollins School of Public Health at Emory University, told Healio.

Graetz and colleagues assessed the frequency of portal use, HbA1c levels and diabetes medication adherence each month between April 2015 and December 2017 among 111,463 adults with diabetes (mean age, 63.79 years; 46.24% women). The researchers determined the type of device participants used to access the portal by reviewing administrative data from the portal. The researchers also reviewed the percentage of days covered each month to determine medication adherence and determined variations in HbA1c with electronic health records.

Changes in portal use

At the end of the study, a greater percentage of participants began accessing the portal via mobile devices and computer (61.71% vs. 34.42%) and refilled prescriptions from the portal (21.83% vs. 7.26%) vs. the study beginning. A smaller percentage of participants accessed the portal by using a computer only (12.98% vs. 29.9%) or not at all (24.5% vs. 34.66%) at study end vs. study beginning.

A photo of a man using a cell phone 
Adults with diabetes achieve more pronounced decreases in HbA1c and more regularly take their medications if they utilize a patient portal system with a mobile device as well as a computer.
Source: Adobe Stock

Percentage of days covered rose by a mean of 1.16 percentage points among participants who began accessing the portal with a computer (95% CI, 0.63-1.7) and by a mean of 1.67 percentage points among those who began using the portal with a computer and mobile device (95% CI, 1.1-2.23) after not accessing the portal at all. Percentage of days covered rose by a mean of 0.5 percentage points for participants who began using a mobile device in addition to a computer after using a computer only (95% CI, 0.18-0.82).

HbA1c fell by a mean of 0.07 percentage points among participants who began using a mobile device in addition to a computer after accessing the portal via computer only (95% CI, –0.09 to –0.06) and by a mean of 0.13 percentage points among participants who had never accessed the portal and then began accessing it with mobile devices and computer (95% CI, –0.16 to –0.1). HbA1c fell by a mean of 0.06 percentage points among participants who had not used the portal before but began accessing it with a computer (95% CI, –0.08 to –0.03).

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“Most health care practices already offer a web-based portal to receive federal incentive payments for electronic health record use,” Graetz said. “Adding mobile access should not be too much of a burden and could be an easy way to reach more patients and improve care.”

‘Higher clinical need’

Percentage of days covered rose by a mean of 3.48 percentage points when computer use was initiated following no use (95% CI, 2.24-4.71) and by a mean of 5.09 percentage points when computer and mobile device use was initiated following no use (95% CI, 3.78-6.4) by participants who had an HbA1c of more than 8% at baseline.

HbA1c fell by a mean of 0.25 percentage points among participants with an HbA1c of more than 8% at baseline who began accessing the portal with a mobile device after never accessing the portal before (95% CI, –0.48 to –0.03) and by a mean of 0.19 percentage points among similar participants who began accessing the portal with a mobile device and computer (95% CI, –0.27 to –0.15). HbA1c also fell by a mean of 0.11 percentage points among participants with a baseline HbA1c of more than 8% who began accessing the portal with a mobile device and computer after using only a computer before (95% CI, –0.16 to –0.06).

“Previously, we found that patients who accessed the portal only from mobile devices were more likely to belong to racial and ethnic minorities, live in lower socioeconomic status neighborhoods, or have lower medication adherence,” Graetz said. “The fact that patients with a higher clinical need who gained only mobile access to the portal experienced the most improvement in blood sugar levels suggests that adding mobile portal access can be an easy way for practices to improve care for vulnerable patients who may face barriers to engaging with healthcare.” – by Phil Neuffer

References:

Graetz I, et al. Am J Manag Care. 2018;doi:24(1):43-48.

For more information:

Ilana Graetz, PhD, can be reached at ilana.graetz@emory.edu; Twitter: @ilana_graetz.

Disclosure: Graetz reports that she has received a research grant from Pfizer.