Managing Patients With Chronic Diseases

A hot topic in medicine is how best to manage populations of patients with chronic diseases such as hypertension and diabetes. As the Baby Boomers age, the sizes of these populations continue to grow. Quality improvement projects across the country are focused on different ways to monitor patients and ensure compliance with treatment regimens—with the goals of controlling disease and improving patients’ quality of life.

An original research study published in the spring issue of the Ochsner Journal looks at the question of whether primary care practice reengineering through the use of patient portals that provide personal health information and access to providers has any effect on service utilization and disease control.

The researchers found that age, sex, race, comorbidities, insurance, prior primary care provider visits, and portal use were associated with changes in utilization, blood pressure, and hemoglobin A1C; however, the strength and direction of these differences varied. An adjusted analysis comparing portal users to nonusers showed an increase in primary care provider and telephone encounter rates but no significant differences in specialty, emergency department, or inpatient hospitalization encounters.

Among patients with a prestudy systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, portal users compared to nonusers had a greater decline in their blood pressure, although the between-group difference was small. Portal users with diabetes compared to nonusers with diabetes also had greater decreases in hemoglobin A1c.

In the health system studied, patient portal implementation emphasized improving accessibility through online scheduling and timely responses to secure messaging. Chronic disease management was not a major focus in the early phases. However, the researchers observed changes in blood pressure and hemoglobin A1c levels that were trending in the desired direction.

For details of the study and statistical analysis, click to Primary Care Practice Reengineering and Associations With Patient Portal Use, Service Utilization, and Disease Control Among Patients With Hypertension and/or Diabetes.

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