JMIR Publications

ABSTRACT

Background:

Patient portal messaging allows individuals to communicate directly with their healthcare providers, offering a flexible way of receiving medical advice between visits. Despite the potential for portal messages to enhance access to care, there is a significant gap in understanding of the types of medical decisions that patients and clinicians make through portal messages.

Objective:

Our objective was to characterize the types of medical decisions that are made through portal messaging among adults with type 2 diabetes.

Methods:

Explanatory-sequential mixed methods study

Results:

Overall, 7,653 individuals (51.9% males, 48.1% females; mean age, 62.9 [SD 14.5] years) were included with an average of 6.7 (SD 8.3) portal message encounters per individual .There were 51,160 message encounters among our study cohort, with an average of 3.2 (SD 2.8) messages per encounter. Of all portal message encounters, 941 (1.8%) were billed, with billed encounters containing more messages per encounter compared to non-billed encounters on average (5.0 [SD 4.8] vs 3.2 [SD 2.7]). Among all billed message encounters, recommendations from the healthcare team involving adjustments or changes to patient medications was the most common content category (“Pharmacologic Recommendation”, 73.0%), followed by patient-initiated questions related to their medications (“Medication Questions”, 64.7%), then medical recommendations from the healthcare team not involving medications (“Non-Pharmacologic Counseling”, 61.4%).

Conclusions:

As national reimbursement policies promote portal messaging to deliver care that would otherwise occur through traditional medical visits, our findings improve our understanding of medical decision-making in portal messages and underscore its role in enhancing patient access to care.