(Press-News.org) CHICAGO – Patients with online access to their medical records and secure e-mail communication with clinicians had increased use of clinical services, including office visits and telephone encounters, compared to patients who did not have online access, according to a study appearing in the November 21 issue of JAMA.
"Using health information technology to foster efficient health care delivery is an important component of health care reform," according to background information in the article. "Prior studies suggest that providing patients with online access to health records and e-mail communication with physicians may substitute for traditional health care services." The presumption is if patients could look up health information online such as their test results, request prescription refills, schedule appointments, or send secure e-mail to clinicians, their use of clinical in-person and telephone calls may decrease. "Many previous studies involved small numbers of patients and were conducted early in the implementation of patient online access."
Ted E. Palen, M.D., Ph.D., M.S.P.H., of the Institute for Health Research, Kaiser Permanente Colorado, Denver, and colleagues investigated the association between patient online access and use of clinical services. The study examined the use of health care services by group members (18 years of age or older) who were continuously enrolled for at least 24 months during the study period March 2005 through June 2010 in Kaiser Permanente Colorado, a group model, integrated health care delivery system. Utilization rates were calculated for both users and nonusers of My Health Manager (MHM), a patient online access system. Member use of online access steadily increased from about 25 percent at the end of 2007 to 54 percent by June 2009 (n = 375,620). More than 45 percent of members with MHM access used at least 1 MHM function. The refined groups each contained 44,321 matched members.
The researchers found that when they compared the use of clinical services before and after the index date between MHM users and nonusers, they saw a significant increase in the per-member rates of office visits (0.7 per member per year) and telephone encounters (0.3 per member per year). "There was also a significant increase in per-1,000-member rates of after-hours clinic visits (18.7 per 1,000 members per year), emergency department encounters (11.2 per 1,000 members per year), and hospitalizations (19.9 per 1,000 members per year) for MHM users compared with nonusers. This utilization pattern was seen for members both younger and older than 50 years." More variability was found in rates of utilization by MHM users with chronic illnesses.
The authors suggest several possible explanations for these findings. "Online access to care may have led to an increase in use of in-person services because of additional health concerns identified through online access. Members might have activated their online access in anticipation of health needs. Members who are already more likely to use services may selectively sign up for online access and then use this technology to gain even more frequent access rather than view it as a substitute for contact with the health care system."
"If these findings are evident in other systems, health care delivery planners and administrators will need to consider how to allocate resources to deal with increased use of clinical services. As online applications become more widespread, health care delivery systems will need to develop methodologies that effectively integrate health information technologies with in-person care."
(JAMA. 2012;308(19):2012-2019; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: This study was supported by the Kaiser Permanente Colorado Regional Initiative Committee Fund. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Palen is employed by the Colorado Permanente Medical Group. Ms. Ross, Mr. Powers, and Dr. Xu are all employees of the Kaiser Permanente Health Plan of Colorado. No other disclosures were repotted.
Please Note: For this study, there will be multimedia content available, including the JAMA Report video, embedded and downloadable video, audio files, text, documents, and related links. This content will be available at 3 p.m. CT Tuesday, November 20 at this link.
Editorial: Personal Health Records and Health Care Utilization
David W. Bates, M.D., M.Sc., and Susan Wells, M.B. Ch.B., of Brigham and Women's Hospital, Boston, write in an accompanying editorial that these findings may be disappointing for patient portal enthusiasts, but should not discourage organizations from increasing the use of electronic health portals by patients.
"Personal health records (PHR) are here to stay, and the tethered architecture appears to offer the most benefits. The data on utilization are uncertain and PHRs may not decrease health care utilization. However, electronic access to PHRs represents an extremely powerful tool from a variety of perspectives and can help empower and engage patients. More data on how to use them and on what specific modules and applications will be beneficial are clearly needed."
(JAMA. 2012;308(19):2034-2036; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: Both authors completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr. Wells reported receiving the 2012/13 Harkness Fellowship in Health Policy and Practice from The Commonwealth Fund. No other disclosures were reported.
###
To contact Ted E. Palen, M.D., Ph.D., M.S.P.H., call Amy Whited at 303-344-7518 or email Amy.L.Whited@kp.org. To contact editorial co-author David W. Bates, M.D., M.Sc., call Lori Schroth at 617-534-1604 or email Ljshanks@partners.org.
END
CHICAGO – Although approved for use for treating traumatic brain injury (TBI) in nearly 60 countries, use of citicoline in a randomized trial that included more than 1,200 participants with TBI did not result in improvement in functional and cognitive status, according to a study appearing in the November 21 issue of JAMA.
"Despite considerable advances in emergency and critical care management of TBI as well as decades of research on potential agents for neuroprotection or enhanced recovery, no effective pharmacotherapy has yet been identified," according to background ...
A rapid test for tuberculosis (TB) could help to reduce TB deaths, improve TB treatment, and also offer reasonably good value for money if introduced in southern Africa, an area that has high rates of HIV and a type of TB that is resistant to some drugs (multi-drug resistant TB), according to a study published in this week's PLOS Medicine.
The World Health Organization (WHO) recently recommended the use of a new diagnostic test for TB (the Xpert MTB/RIF test), which can show a result within 2 hours, in people at high risk of multi-drug resistant TB and/or HIV-associated ...
Models used for predicting the likelihood of individuals developing chronic kidney disease and for predicting disease progression in people who already have the condition are useful tools but not yet robust enough to help inform clinical guidelines, according to a study published in this week's PLOS Medicine.
Chronic kidney disease is a common but serious condition which can lead to kidney failure. The condition cannot be cured but progression of the disease can be slowed by controlling high blood pressure and diabetes, both causes of chronic kidney disease, and by adopting ...
In this week's PLOS Medicine, Charles Weijer and colleagues present the Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials, which aims to provide researchers and research ethics committees with detailed guidance on the ethical design, conduct, and review of CRTs.
###
Funding: This work was supported by the Canadian Institutes of Health Research (grant numbers MOP85066, MOP89790). CW and JMG hold Tier I Canada Research Chairs. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the ...
New drugs derived from components of a specific diet used by children with severe, drug-resistant epilepsy could offer a new treatment, according to research published today in the journal Neuropharmacology.
Scientists from Royal Holloway, in collaboration with University College London, have identified specific fatty acids that have potent antiepileptic effects, which could help control seizures in children and adults.
The discovery could lead to the replacement of the ketogenic diet, which is often prescribed for children with severe drug-resistant epilepsy. The ...
Scientists from Queen Mary, University of London have sequenced the genetic code of a birch tree for the first time, which could help protect British birch populations.
The genome, which is around 450 million letters, will help researchers understand the genetic basis of traits such as disease resistance and growth shape.
There are over sixty species of birch trees around the world, with huge ecological and commercial importance. They are an essential part of the Boreal forest located around the North Pole, which is the world's largest land-based ecosystem. The team ...
It appears that it's not just us Brits who are fascinated with the UK weather.
A group of researchers from Germany has taken to investigating the potential changes in extreme rainfall patterns across the UK as a result of future global warming and has found that in some regions, the time of year when we see the heaviest rainfall is set to shift.
The study, published today, 21 November, in IOP Publishing's journal Environmental Research Letters, finds that between 2061 and 2100, the south-east of the country will likely experience its most extreme rainfall later in the ...
Research: Muscular strength in male adolescents and premature death: cohort study of one million participants
Low muscle strength in adolescence is strongly associated with a greater risk of early death from several major causes, suggests a large study published on bmj.com today.
The effect is similar to well established risk factors for early death like being overweight or having high blood pressure, leading the authors to call for young people, particularly those with very low strength, to engage in regular physical activity to boost their muscular fitness.
High ...
Research: General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis
Editorial: The value of conducting periodic health checks
Researchers have found that routine general health checks, which have become common practice in some countries, do not reduce the number of deaths from cardiovascular disease or cancer. They do, however, increase the number of new diagnoses.
Health checks were defined as screening for more than one disease or risk factor in more than one organ system offered to a general ...
How flowers have evolved particular colours, shapes and scents to attract pollinators has long fascinated ecologists. Now, using artificial flowers and high-speed video, researchers have gained intriguing insights into the intimate relationship between hummingbirds and the flowers they pollinate. The study, published in the British Ecological Society's journal Functional Ecology, is the first to measure how much energy hummingbirds use while hovering to feed from flowers of different orientation.
Hummingbirds are among the smallest and most brightly-coloured birds on Earth, ...
