Use of a patient portal to refill prescriptions online was associated with increased medication adherence and lower LDL cholesterol in people with diabetes, according to a study of patients who used the Kaiser Permanente portal. The study's results could have broad implications, not only for Kaiser members, but also for millions of others who are expected to use patient portals that are being rolled out to meet the requirements of Meaningful Use Stage 2.
Moreover, this research presents a sharp contrast to a recent review paper that suggested the health benefits of portals are unclear.
Published in Medical Care, the new study was carried out by researchers at Kaiser Permanente and the University of California San Francisco with funding from the National Institutes of Health. The researchers followed 17,760 diabetic patients who used the kp.org portal, which allows users to schedule appointments, view their health records and lab results, and securely message with their providers, among other tasks. During the study period from 2006 to 2010, 8,705 of the subjects started using the portal to request refills online, either occasionally or exclusively. The rest used the portal for other purposes, but not for refill requests.
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Non-adherence to prescribed statin medications did not decrease in this reference group, but it did among those using the portal for refills. Among the patients who ordered refills exclusively through the portal, non-adherence declined 6% after adjusting for changes in non-adherence in the reference group. Similar decreases in LDL cholesterol were seen among exclusive users. Changes for occasional users in both areas were not significant.
The patients were racially and ethnically diverse, and their mean age was 62. Most had LDL numbers within a similar range, though medication adherence was a bit higher in the reference group at baseline. The study's pre-post design and the inclusion of a reference group were said to reduce the possibility of selection bias. Still, because it was an observational study, no causal connection could be established between portal use and adherence.
Assuming there was a cause-and-effect relationship, the increased adherence was likely the result of that fact that ordering refills online was easier, Andrew Karter, a research scientist at the Kaiser Permanente Research Division and a study coauthor, told InformationWeek Healthcare. It's very convenient for any patient with a computer to order refills on the portal, he said, and that convenience made patients more likely to refill in a timely fashion.
Karter said it was doubtful that access to medical records on the portal had much impact on the increased adherence, because the reference group had the same access. In a Harvard Medical School study published in 2012, the majority of patients who were given access to their physicians' notes improved their medication adherence. But Karter said that study is not relevant to the Kaiser trial.
Among patients who were non-adherent to statins in the baseline period, those who started using the online refill function exclusively had a 6% decrease in the prevalence of poor LDL control. The researchers' analysis showed that this change resulted partly from improved adherence following initiation of the refill function. That would make sense, he said, since statins reduce LDL cholesterol.
Based on the "modest but substantive" study results, Karter surmised that many other Kaiser members who don't have diabetes could benefit from requesting refills through the portal. About half of all Kaiser members use kp.org, and a major increase in the use of patient portals nationally could improve medication adherence and outcomes.
"I think there are unintended benefits of portals," he said. "They're very hard to measure and isolate, but there are probably quite a few of them. When you add together the patient convenience, the pharmacy operations efficiency, and this unexpected benefit of increased adherence and better health outcomes, it seems like a really good deal."
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