The Impact of Patient Online Access to Computerized Medical Records and Services on Type 2 Diabetes: Systematic Review

Author(s): Freda Mold , BSc (Hons), PhD ¹ ^, , Mary Raleigh , BSc, RN, RNT, MSc, DClinPractice ² , Nouf Sahal Alharbi , BSc, MSc, PhD ³ , Simon de Lusignan , BSc, MB BS, MSc, MD (Res) ⁴

Editor(s): Gunther Eysenbach

Other contributor(s): Yanshan Wang (Reviewer), Puneet Seth (Reviewer), Justin St-Maurice (Reviewer)

Publication date (Electronic): 06 July 2018

Journal: Journal of Medical Internet Research

Publisher: JMIR Publications

Keywords: medical records, online access, online services, medical records systems, computerized, computers, primary care, type 2 diabetes mellitus

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Abstract

Background

Online access to computerized medical records has the potential to improve convenience, satisfaction, and care for patients, and to facilitate more efficient organization and delivery of care.

Objective

The objective of this review is to explore the use and impact of having online access to computerized medical records and services for patients with type 2 diabetes mellitus in primary care.

Methods

Multiple international databases including Medline, Embase, CINAHL, PsycINFO and the Cochrane Library were searched between 2004 and 2016. No limitations were placed on study design, though we applied detailed inclusion and exclusion criteria to each study. Thematic analysis was used to synthesize the evidence. The Mixed Methods Appraisal Toolkit was used to appraise study quality.

Results

A search identified 917 studies, of which 28 were included. Five themes were identified: (1) disparities in uptake by age, gender, ethnicity, educational attainment, and number of comorbidities, with young men in full-time employment using these services most; (2) improved health outcomes: glycemic control was improved, but blood pressure results were mixed; (3) self-management support from improved self-care and shared management occurred especially soon after diagnosis and when complications emerged. There was a generally positive effect on physician-patient relationships; (4) accessibility: patients valued more convenient access when online access to computerized medical records and services work; and (5) technical challenges, barriers to use, and system features that impacted patient and physician use. The Mixed Methods Appraisal Toolkit rated 3 studies as 100%, 19 studies as 75%, 4 studies as 50%, and 1 study scored only 25%.

Conclusions

Patients valued online access to computerized medical records and services, although in its current state of development it may increase disparities. Online access to computerized medical records appears to be safe and is associated with improved glycemic control, but there was a lack of rigorous evidence in terms of positive health outcomes for other complications, such as blood pressure. Patients remain concerned about how these systems work, the rules, and timeliness of using these systems.

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Most cited references 48

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Qualitative Content Analysis

Philipp Mayring (2000)

The article describes an approach of systematic, rule guided qualitative text analysis, which tries to preserve some methodological strengths of quantitative content analysis and widen them to a concept of qualitative procedure. First the development of content analysis is delineated and the basic principles are explained (units of analysis, step models, working with categories, validity and reliability). Then the central procedures of qualitative content analysis, inductive development of categories and deductive application of categories, are worked out. The possibilities of computer programs in supporting those qualitative steps of analysis are shown and the possibilities and limits of the approach are discussed. URN: urn:nbn:de:0114-fqs0002204 Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, Vol 1, No 2 (2000): Qualitative Methods in Various Disciplines I: Psychology

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The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system-results from the diabetes study of northern California (DISTANCE).

Urmimala Sarkar, Andrew Karter, Jennifer Liu … (2010)

Internet-based patient portals are intended to improve access and quality, and will play an increasingly important role in health care, especially for diabetes and other chronic diseases. Diabetes patients with limited health literacy have worse health outcomes, and limited health literacy may be a barrier to effectively utilizing internet-based health access services. We investigated use of an internet-based patient portal among a well characterized population of adults with diabetes. We estimated health literacy using three validated self-report items. We explored the independent association between health literacy and use of the internet-based patient portal, adjusted for age, gender, race/ethnicity, educational attainment, and income. Among 14,102 participants (28% non-Hispanic White, 14% Latino, 21% African-American, 9% Asian, 12% Filipino, and 17% multiracial or other ethnicity), 6099 (62%) reported some limitation in health literacy, and 5671 (40%) respondents completed registration for the patient portal registration. In adjusted analyses, those with limited health literacy had higher odds of never signing on to the patient portal (OR 1.7, 1.4 to 1.9) compared with those who did not report any health literacy limitation. Even among those with internet access, the relationship between health literacy and patient portal use persisted (OR 1.4, 95% CI 1.2 to 1.8). Diabetes patients reporting limited health literacy were less likely to both access and navigate an internet-based patient portal than those with adequate health literacy. Although the internet has potential to greatly expand the capacity and reach of health care systems, current use patterns suggest that, in the absence of participatory design efforts involving those with limited health literacy, those most at risk for poor diabetes health outcomes will fall further behind if health systems increasingly rely on internet-based services.

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A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus.

Steven Shea, Ruth S. Weinstock, Justin B Starren … (2015)

Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness. The authors conducted a randomized, controlled trial comparing telemedicine case management to usual care, with blinding of those obtaining outcome data, in 1,665 Medicare recipients with diabetes, aged 55 years or greater, and living in federally designated medically underserved areas of New York State. The primary endpoints were HgbA1c, blood pressure, and low-density lipoprotein (LDL) cholesterol levels. In the intervention group (n = 844), mean HgbA1c improved over one year from 7.35% to 6.97% and from 8.35% to 7.42% in the subgroup with baseline HgbA1c > or =7% (n = 353). In the usual care group (n = 821) mean HgbA1c improved over one year from 7.42% to 7.17%. Adjusted net reductions (one-year minus baseline mean values in each group, compared between groups) favoring the intervention were as follows: HgbA1c, 0.18% (p = 0.006), systolic and diastolic blood pressure, 3.4 (p = 0.001) and 1.9 mm Hg (p or =7%, net adjusted reduction in HgbA1c favoring the intervention group was 0.32% (p = 0.002). Mean LDL cholesterol level in the intervention group at one year was 95.7 mg/dL. The intervention effects were similar in magnitude in the subgroups living in New York City and upstate New York. Telemedicine case management improved glycemic control, blood pressure levels, and total and LDL cholesterol levels at one year of follow-up.

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Author and article information

Contributors

Freda Mold:

School of Health SciencesFaculty of Health and Medical SciencesUniversity of SurreyDuke of Kent BuildingStag Hill CampusGuildford, GU2 7XHUnited Kingdom44 01483 684636freda.mold@surrey.ac.uk

ORCID: http://orcid.org/0000-0002-6279-5537

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J. Med. Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: July 2018

Publication date (Electronic): 06 July 2018

Volume: 20

Issue: 7

Electronic Location Identifier: e235

Affiliations

[1] ¹ School of Health Sciences Faculty of Health and Medical Sciences University of Surrey Guildford United Kingdom

[2] ² Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care King's College London London United Kingdom

[3] ³ Department of Health Sciences College of Applied Studies & Community Service King Saud University Riyadh Saudi Arabia

[4] ⁴ Department of Clinical and Experimental Medicine Faculty of Health and Medical Sciences University of Surrey Guildford United Kingdom

Author notes

Corresponding Author: Freda Mold freda.mold@ 123456surrey.ac.uk

Author information

Freda Mold http://orcid.org/0000-0002-6279-5537

Mary Raleigh http://orcid.org/0000-0002-8481-1278

Nouf Sahal Alharbi http://orcid.org/0000-0002-4431-3303

Simon de Lusignan http://orcid.org/0000-0002-8553-2641

Article

Publisher ID: v20i7e235

DOI: 10.2196/jmir.7858

PMC ID: 6054706

PubMed ID: 29980499

SO-VID: 9b0769d5-6577-4870-b837-c9c2ac079cb2

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/.as well as this copyright and license information must be included.

History

Date received : 4 May 2017

Date revision requested : 25 July 2017

Date revision received : 28 November 2017

Date accepted : 15 May 2018

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