JMIR Publications

ABSTRACT

Background:

Web-based patient portals are increasingly being used to support chronic disease management by improving patient-provider communication and promoting treatment adherence. Studies have found that patients perceive portal messaging systems as helpful tools to communicate with care team members, however the role of portal messaging in Inflammatory Bowel Disease (IBD) needs additional investigation.

Objective:

This study aims to identify IBD patients’ portal messaging patterns at an urban academic university to direct future digital health strategy development.

Methods:

A retrospective cohort study was conducted using electronic health record data from an urban academic university. All patients with a diagnosis of Crohn’s disease, ulcerative colitis, or IBD-unspecified were identified, along with demographic details such as age, sex, and race. Frequency of portal messaging activity was extracted, and associations between portal messaging intensity and clinical outcomes (disease activity and healthcare utilization) were analyzed using descriptive statistics and Chi Square tests of association. Statistical significance was set at P<.05.

Results:

Among 442 patients with IBD (182 with ulcerative colitis, 249 with Crohn’s disease, and 11 with indeterminate colitis), 196 were White, 161 were Black, 7 were Asian, 28 were of other races, and 50 had unknown race (253 female sex and 189 male sex). 78.5% of patients sent at least one portal message within the last 2 years. Portal messaging intensity varied significantly across age and disease activity. Only 11.8% of middle-aged patients 40-60 years old sent 6+ messages over the last 2 years in comparison to 33.7% of patients < 40 years old and 33.6% of patients >60 years old (P<.001, df =1, chi-square statistic=20.6 and P<.001, df=1, chi-square statistic=17.5). Messaging intensity also differed by disease activity (P=.047, df =1, chi-square statistic= 3.9), with 12.5% of patients with active disease sending 16 or more portal messages in the last 2 years in comparison to just 6% of patients in remission or with unknown disease activity. No significant associations were observed between messaging intensity and sex, race, or IBD subtype.

Conclusions:

This study analyzed portal messaging activity among patients with IBD and demonstrated that a large majority of patients with IBD have utilized the electronic messaging function within the web-based patient portal at a large urban academic university. This study found that middle aged patients 40-60 were significantly less engaged in electronic communication in comparison to younger (< 40 years) and older (>60 years) patients. Patients with active disease were significantly more likely to send on average 8 or more messages per year, suggesting that portal messaging is a tool for reporting and managing active disease. These results amplify the potential benefits of portal messaging in IBD care. Electronic messaging and digital engagement through targeted outreach can potentially improve communication and outcomes in IBD management.