Patient-Provider Electronic Messenger in Chronic Illness

The purpose of this study was to conduct a retrospective analysis of a large and uniform patient secure messaging (SM) application at Group Health Cooperative. Predictors of SM use among the general enrollee population and enrollee populations with diabetes, depression, and congestive heart failure were examined. Also, the association between SM use and glycemic, lipid, and blood pressure control among enrollees with diabetes was examined. The study included a retrospective cohort of health plan enrollees over the age of 18 years who were continuously enrolled from October of 2003 through April of 2005 at Group Health, a mixed-model health care system based in Seattle, Washington. Findings included the following: among all eligible enrollees, 14% (29,196) exchanged one or more SM with a primary or specialty care provider between January 1st, 2004 and March 31st of 2005. Higher SM use by enrollees was independently associated female gender (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.09-1.19), greater anticipated clinical need (OR, 3.46; 95% CI, 3.11-3.85, comparing high or very high to very low anticipated clinical need), and the primary care provider's use of SM with other patients (OR, 1.94; 95% CI, 1.70-2.22, comparing 20-50 % vs [greater than or equal to] 10% encounters through SM). Less SM use was associated with enrollee age over 65 years (OR, 0.63; CI, 0.58-0.67) and Medicaid insurance vs. private insurance (OR, 0.80; 95 % CI, 0.67-0.95). We found limited differences in characteristics associated with SM use in the general enrollee population compared to those with depression, diabetes, and congestive heart failure. In adjusted analyses of enrollees with diabetes, SM use was positively associated with having a low density lipoprotein < 130 mg/dL (OR, 1.21; 95% CI, 1.04-1.41) and a hemoglobin A1c < 7% (OR, 1.38; 95% CI, 1.25-1.52), but not a blood pressure < 130/80 mm Hg (OR, 1.10; 95% CI, 0.97-1.25). In conclusion, enrollees who used SM were largely the same as those that use other health care services, with the exceptions of less SM use among enrollees over the age of 65 years and those having Medicaid insurance. SM use was associated with better glycemic and blood pressure control in patients with diabetes. These findings support further use and investigation of secure patient-provider messaging in patients with chronic conditions.