JMIR Publications

ABSTRACT

Background:

Although patient secure messaging (SM) engagement has been associated with improved diabetes outcomes, it remains unclear whether care partners (family members or friends) might enhance use.

Objective:

To examine whether extent of SM use differs among older patients with diabetes based on the presence or absence of care partner proxies.

Methods:

This is a cohort study taking place in a large, fully integrated healthcare delivery system with an established online patient portal serving over 4 million patients. Participants included patients with type 2 diabetes ≥ 50 yrs. old, newly registered on the patient portal, who sent ≥ 1 English-language SM to their clinician between July 1, 2006 and Dec. 31, 2015. Care partner SM proxy use was identified by having a registered proxy or, to identify non-registered proxies, by applying a computational linguistics algorithm. The primary outcome was annual volume of SMs (sent or received); secondary outcomes were time to first SM sent by patient or proxy and number of annual SM exchanges (unique message topics generating ≥1 reply).

Results:

Mean age of the cohort (n=7,659) at study start was 61 yrs.; 75% were married, 30% identified as White, 15% Black, 13% Latino, 12% Filipino, and 10% Chinese. Forty-nine percent of patients used a proxy to some extent. Compared to non-proxy users, proxy users were older (P<.001), had lower educational attainment (P<.001) and more comorbidities (P<.001). After adjusting for patient sociodemographic and clinical characteristics, proxy users had greater annual SM volume (20.7, [95% CI, 20.2 - 21.2)] vs. 10.9, [95% CI , 10.7 - 11.2)], P<.001), shorter time to SM initiation (HR vs non-users: 1.30, [95% CI, 1.24 - 1.37)], P<.001), and more annual SM exchanges (6.0, [95% CI, 5.8 - 6.1)] vs. 2.9, [95% CI, 2.9 - 3.0)], P<.001). Differences in SM engagement by proxy status were similar across patient levels of education, racial and ethnic groups.

Conclusions:

Among a cohort of older patients with diabetes, proxy SM involvement was independently associated with increased intensity and earlier initiation of messaging. Future studies should examine the effect of care partners’ SM involvement on diabetes-related quality of care and clinical outcomes.