Introduction
Diabetes is among the most concerning conditions for the population’s well-being. Due to the rising prevalence of diabetes among adults and the complex nature of self-management necessitated by ongoing therapy modifications, managing diabetes remains difficult. To ensure adherence to treatment plans that fit patients’ needs and preferences, it is crucial to involve patients in the self-management of their condition.
Diabetes treatment relies heavily on improving clinical decision-making for more thorough and tailored patient care, which can be achieved through health information technology. In this context, the current paper summarizes evidence from the scholarly field on how personal health records (PHR) and online medical portals contribute to treating people recently diagnosed with diabetes.
Review of Scholarly Evidence
Davis, S., & MacKay, L. (2020). Moving beyond the rhetoric of shared decision-making: Designing personal health record technology with young adults with type 1 diabetes. Canadian Journal of Diabetes, 44(5), 434-441. Web.
The given article studies the cases of type 1 diabetes (T1D) in young adults. This stage of life is associated with high risk for these people due to both the difficulties of adolescence and the pediatric-to-adult care transition. Hence, developing cutting-edge technology and methods for engagement and taking preventative measures is crucial.
Davis and MacKay (2020) highlighted PHR – an online system that patients can use to manage their health information and interact with providers – and shared decision-making (SDM) as potential solutions for the given issue. To achieve the best health outcomes, these solutions have to be combined, which is impossible considering PHR’s current state (Davis & MacKay, 2020). After identifying this gap, researchers investigated the possibility of PHR design allowing SDM integration.
The research was conducted with two study groups: the patient group, consisting of young T1D adults, and the healthcare provider group, consisting of various medical personnel. It was divided into two stages: the review of a user-centered application design and an interview. The review required participants to connect different SDM traits to PHR functionalities and rate their perceived usefulness. In turn, the interview was used to discover the reasoning behind specific choices made during the review. The following data were analyzed to determine the functions’ necessity and mapping saturation.
The research did a great job of comparing and contrasting the views of patients and providers on what the SDM design of a PHR should be. Generally, there was a “moderate level of agreement between patients and care providers about the rating of every PHR function” (Davis & MacKay, 2020, p. 446). Meanwhile, the differences between the study groups reflect a lack of patients’ understanding of providers’ working routines and responsibilities.
For instance, patients would appreciate the ability to notify their practitioners when they need to decide (Davis & MacKay, 2020). However, practitioners complained about notification fatigue caused by the constant need to assess the importance and acuity of the notification (Davis & MacKay, 2020). The article highlights how SDM practice can engage patients and increase their T1D awareness and treatment outcomes. The article’s main weakness lies in the non-representable sample size that puts limits on the results’ generalization.
Mold, F., Raleigh, M., Alharbi, N. S., & De Lusignan, S. (2018). The impact of patient online access to computerized medical records and services on type 2 diabetes: Systematic review. Journal of Medical Internet Research, 20(7), 1-16. Web.
This article focuses on the general impact of having online access to a PHR system among T2DM patients in primary care. It has multiple objectives fall into the following categories: First, the research intended to identify PHR users, non-users, and their caregivers (Mold et al., 2018). Secondly, they sought to determine the impact of PHR on T2DM health outcomes (Mold et al., 2018).
Thirdly, the collective was interested in the PHR’s impact on particular components, such as T2DM management and service access and delivery (Mold et al., 2018). Finally, the team aimed to locate specific challenges and barriers that hinder the adoption of PHR among patients (Mold et al., 2018). The study aims to identify potential knowledge gaps in the current practice and map the respective PHR system design requirements.
The review has an organized, logical structure based on predefined inclusion and exclusion criteria. After an initial automated search using index items and keywords, researchers screened the articles for duplicates and then personally checked their adherence to defined criteria. Out of almost 10,000 articles located, 28 were consequently chosen for the full review (Mold et al., 2018). The findings presented in the systematic review result from data extraction, quality appraisal, and analysis of these 28 articles.
The review results yielded five themes regarding PHR use among T2DM patients. Mainly, Mold et al. (2018) define them as:
- disparities in use,
- improved health outcomes,
- enhanced self-management support,
- accessibility, and
- technical challenges, barriers to use, and system features (p. 4).
In this context, disparities were caused by various demographic factors and disease severity.
The use of PHR proved to be positively associated with health outcomes, such as glycemic control and responsible care management (Mold et al., 2018). Additionally, PHR contributed to an increase in the quality of self-management and interaction levels via secure messages between patients and providers (Mold et al., 2018). Lastly, the barriers were poor internet connection, poor digital literacy, and bias toward PHR (Mold et al., 2018).
One specific barrier was highlighted regarding patients recently diagnosed with T2DM – they preferred personal communication to PHR to receive assistance in learning how to use PHR. Generally speaking, the article provided sufficient answers according to the established goals. The only minor limitation can be attributed to the thorough delineation of predefined inclusion and exclusion criteria, which narrowed the research scope.
Sun, R., Burke, L. E., Saul, M. I., Korytkowski, M. T., Li, D., & Sereika, S. M. (2019). Use of a patient portal for engaging patients with type 2 diabetes: Patterns and prediction. Diabetes Technology & Therapeutics, 21(10), 546-556. Web.
This article focuses on PHR systems’ use patterns and predictors among people diagnosed with T2DM. Understanding when people use the portal, who uses it, and which features they utilize while accessing it is crucial, given the growing interest in medical portals and the expectation that they will positively influence patient outcomes. This study’s objectives were to explain how patients with T2DM utilized the PHR portal over time, including which features they used and when. In addition, the study aimed to explore the relationships between patient demographics, clinical variables, and portal use.
The research design represents a longitudinal retrospective cohort spanning over two years. The authors obtained various demographic, socioeconomic, clinical, and portal-use statistics from the University of Pittsburgh Medical Center Physician Services (Sun et al., 2019). The peculiar notion regarding the demographic variables is that the study took the geographical location of patients into account to incorporate the potential effect of urbanization on the predictors and health outcomes.
Researchers came to the following conclusions based on the statistical analysis of the obtained data. Firstly, over 70% of patients constantly used the PHR portal, implying that the portal and the data acquisition were convenient and engaging enough (Sun et al., 2019). Secondly, patients tended to log in after receiving the notification regarding portal upgrades or before a scheduled practitioner visit (Sun et al., 2019). Thirdly, rural areas with poorer internet accessibility showcased less frequent portal use (Sun et al., 2019).
Finally, there is a significant barrier in poor technology adoption rates, as two-thirds of the sample did not engage with the portal (Sun et al., 2019). The main implication of these findings is that consistent patient engagement promotes the use of PHR, which, in turn, facilitates improvements in health outcomes. In addition, bias toward technological solutions and digital illiteracy substantially threaten the population’s health. Overall, the study did manage to identify the specificity of the mentioned patterns of portal use. However, using data from a single healthcare organization and online system limits the generalization of the results.
Zocchi, M. S., Robinson, S. A., Ash, A. S., Vimalananda, V. G., Wolfe, H. L., Hogan, T. P., & Shimada, S. L. (2021). Patient portal engagement and diabetes management among new portal users in the Veterans Health Administration. Journal of the American Medical Informatics Association, 28(10), 2176-2183. Web.
This article aims to investigate whether using the PHR portal among the Veterans Health Administration (VHA) patients positively contributes to diabetes-related health outcomes. Specifically, Zocchi et al. (2021) were interested in the physiological measures of patients, including “hemoglobin A1c (HbA1c), low-density lipoproteins (LDLs), and blood pressure (BP) in the first three years of portal use” (p. 2176). Apart from that, researchers intended to contribute to the study field by conducting a study that spans a considerable amount of time, three years, since initial portal registration.
To achieve the desired results, the study was designed as a retrospective cohort of VHA patients diagnosed with T2DM, excluding individuals who already had an account before diagnosis. The authors collected the patient-level portal activity data in connection with administrative PHR information (Zocchi et al., 2021). In addition, they gained access to demographic, healthcare utilization, diagnostic, and laboratory data (Zocchi et al., 2021). Finally, a statistical analysis was applied to the gathered information.
Overall, the study achieved its goal of linking the time of PHR use with physiological variables. According to Zocchi et al. (2021), among patients who displayed poor self-management, the study discovered a positive association between time after registration and lower annual values of HbA1c and LDL. Measurements of BP also showed a tendency to decrease, but the change cannot be considered statistically significant.
Based on these pieces of evidence, the authors concluded that consistent PHR use is a viable solution for patients struggling with self-management during treatment. The research’s main strength lies in its solid applicability to the target population due to its large sample size and significant time frame. Among its limitations is the authors’ inability to measure specific subjective factors, such as an individual’s overall self-management capability. Additionally, the impact of distinct portal features was also left out of the scope of the research.
Conclusion
Considering all the evidence presented in these four studies, it is possible to draw several definitive conclusions. PHR systems and medical portals are positively associated with improved health outcomes. This is achieved through increased patient engagement in the treatment process, ease of access to vital reference points necessary during the treatment, and promotion of self-management. Apart from that, several potential improvements could further contribute to the population’s health. In particular, as Davis and MacKay (2020) mentioned, incorporating SDM would ease the burden of limited knowledge among the patients.
In terms of newly diagnosed patients, several implications are also indicated by the chosen studies. According to Davis & MacKay (2020), Mold et al. (2018), and Sun et al. (2019), these patients are in great need of practitioners’ guidance in terms of treatment development and maintenance. Meanwhile, Zocchi et al. (2021) provide time-verified proof of favorable health outcomes for new medical portal users. Therefore, the benefits of PHR as a technological solution are apparent and should be continually prioritized by healthcare providers and organizations.