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01-01-2012 | Original Research

Randomized Controlled Trial of Health Maintenance Reminders Provided Directly to Patients Through an Electronic PHR

Authors: Adam Wright, PhD, Eric G. Poon, MD, MPH, Jonathan Wald, MD, MPH, Joshua Feblowitz, MS, Justine E. Pang, Jeffrey L. Schnipper, MD, MPH, Richard W. Grant, MD, MPH, Tejal K. Gandhi, MD, MPH, Lynn A. Volk, MHS, Amy Bloom, MPH, Deborah H. Williams, MHA, Kate Gardner, Marianna Epstein, Lisa Nelson, Alex Businger, Qi Li, MD, MBA, David W. Bates, MD, MSc, Blackford Middleton, MD, MPH, MSc

Published in: Journal of General Internal Medicine | Issue 1/2012

Abstract

BACKGROUND

Provider and patient reminders can be effective in increasing rates of preventive screenings and vaccinations. However, the effect of patient-directed electronic reminders is understudied.

OBJECTIVE

To determine whether providing reminders directly to patients via an electronic Personal Health Record (PHR) improved adherence to care recommendations.

DESIGN

We conducted a cluster randomized trial without blinding from 2005 to 2007 at 11 primary care practices in the Partners HealthCare system.

PARTICIPANTS

A total of 21,533 patients with access to a PHR were invited to the study, and 3,979 (18.5%) consented to enroll.

INTERVENTIONS

Patients in the intervention arm received health maintenance (HM) reminders via a secure PHR “eJournal,” which allowed them to review and update HM and family history information. Patients in the active control arm received access to an eJournal that allowed them to input and review information related to medications, allergies and diabetes management.

MAIN MEASURES

The primary outcome measure was adherence to guideline-based care recommendations.

KEY RESULTS

Intention-to-treat analysis showed that patients in the intervention arm were significantly more likely to receive mammography (48.6% vs 29.5%, p = 0.006) and influenza vaccinations (22.0% vs 14.0%, p = 0.018). No significant improvement was observed in rates of other screenings. Although Pap smear completion rates were higher in the intervention arm (41.0% vs 10.4%, p < 0.001), this finding was no longer significant after excluding women’s health clinics. Additional on-treatment analysis showed significant increases in mammography (p = 0.019) and influenza vaccination (p = 0.015) for intervention arm patients who opened an eJournal compared to control arm patients, but no differences for any measure among patients who did not open an eJournal.

CONCLUSIONS

Providing patients with HM reminders via a PHR may be effective in improving some elements of preventive care.

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Title: Randomized Controlled Trial of Health Maintenance Reminders Provided Directly to Patients Through an Electronic PHR
Authors: Adam Wright, PhD
Eric G. Poon, MD, MPH
Jonathan Wald, MD, MPH
Joshua Feblowitz, MS
Justine E. Pang
Jeffrey L. Schnipper, MD, MPH
Richard W. Grant, MD, MPH
Tejal K. Gandhi, MD, MPH
Lynn A. Volk, MHS
Amy Bloom, MPH
Deborah H. Williams, MHA
Kate Gardner
Marianna Epstein
Lisa Nelson
Alex Businger
Qi Li, MD, MBA
David W. Bates, MD, MSc
Blackford Middleton, MD, MPH, MSc
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 1/2012
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-011-1859-6

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Abstract

BACKGROUND

OBJECTIVE

DESIGN

PARTICIPANTS

INTERVENTIONS

MAIN MEASURES

KEY RESULTS

CONCLUSIONS

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