Providing patients with computer patient portal access in combination with mobile portal access is associated with significantly improved diabetes medication adherence and glycemic control, according to results of a retrospective cohort study published in JAMA Network Open.
The addition of mobile patient portal access has been shown to increase the frequency of portal use, which is associated with lower glycemic levels among patients with diabetes and improved medication adherence to statins and antihypertensives. No studies have examined whether mobile portal access is associated with adherence to oral diabetes medication or glycemic levels for patients with diabetes.
To evaluate this, data from 111,463 Kaiser Permanente of Northern California patients (53.76% men) were used to evaluate the association of the use of a free patient portal with glycemic levels, hemoglobin A1c (HbA1c) levels, and medication adherence. The average age of patients was 63.79±12.93 years. Patients who were ≥18 years of age, diagnosed with diabetes, and active members of Kaiser Permanente of Northern California who had filled at least 1 prescription for an oral diabetes medication (≥30 days’ supply) in the year before the study began were included. Because of the difficulty of evaluating insulin medication adherence, patients who had filled a prescription for insulin in the year before or at any time during the study were excluded.
Medication adherence was measured by monthly percentage of days covered (PDC), which was calculated using the number of days’ supply of oral diabetes prescription medication dispensed each month in the study. Patients were considered adherent if they had a PDC of ≥80%.
The mobile portal became available in 2013, shortly before the study period began on April 1, 2015. Until December 31, 2017, portal access of patients was assessed and categorized into 1 of 4 groups: never used, computer only, mobile only, or computer and mobile.
The percentage of patients who used the portal on both a computer and mobile device increased from 34.42% in April 2015 to 61.71% in December 2017. Among patients with no prior portal access, addition of computer-only portal access was associated with an increase in PDC of 1.16% (95% CI, 0.63-1.70; P <.001) and a change in HbA1c of -0.06% (95% CI, -0.08 to -0.03; P <.001). Introducing both mobile and computer portal access was linked to an increase in PDC of 1.67% (95% CI, 1.10-2.23; P <.001) and a change of -0.13% (95% CI, -0.16 to -0.10; P <.001) in HbA1c level. For patients who had already accessed the portal from a computer, addition of mobile access was associated with an increase in PDC of 0.50% (95% CI, 0.18-0.82; P =.002) and a change in HbA1c of -0.07% (95% CI, -0.09 to -0.06; P <.001).
Among patients with higher baseline HbA1c level (>8.0%), a change from no portal access to both computer and mobile access was associated with an increase in PDC of 5.09% (95% CI, 3.78-6.40; P <.001) and a change of -0.19% (95% CI, -0.27 to -0.15; P <.001) in HbA1c level, whereas introduction of mobile access alone was associated with a change in HbA1c of -0.25% (95% CI, -0.48 to -0.03; P =.03). Introduction of mobile access to patients who already had computer access was associated with a change of -0.11% (95% CI, -0.16 to -0.06; P <.001) in HbA1c level.
For patients who had not previously accessed the portal at baseline, addition of mobile access alone was not associated with statistically significant changes in PDC.
These results showed that adding mobile access to a health portal for patients not previously using the service or using it only from a computer resulted in statistically significant improvements in adherence to oral diabetes drugs and glycemic levels. Importantly, greater improvements associated with mobile portal access were found in patients with higher clinical need at baseline (HbA1c level >8%). The added convenience of managing care through a mobile device may contribute to improved self-management of a patient’s medical care, especially for patients with high clinical need.
Graetz I, Huang J, Muelly ER, Fireman B, Hsu J, Reed M. Association of mobile patient portal access with diabetes medication adherence and glycemic levels among adults with diabetes. JAMA Netw Open. 2020;3(2):e1921429.