Study Finds that Physician-Patient Emails Help Improve Care

Patients saw improved blood glucose and blood pressure levels

A study published in Health Affairs found that the use of secure physician-patient email was associated with a statistically significant improvement in the effectiveness of care for patients with diabetes, hypertension, or both.

Adults with access to the Internet want secure physician-patient messaging, and early research regarding its impact on quality of care has been positive. With the current study, the authors evaluated secure physician-patient email and the Healthcare Effectiveness Data and Information Set (HEDIS) effectiveness-of-care measures for a large population of adults with diabetes, hypertension, or both. The authors focused on those conditions because of their high prevalence and costs of care.

The authors analyzed 630,807 individual messages among 35,423 adult patients and 3,092 primary care physicians that took place between March 2006 and December 2008. They then compared the messages to baseline data from February 2005 to February 2006. For patients with diabetes, the authors assessed all comprehensive diabetes care measures, including glycemic (hemoglobin A1c or HbA1c) screening, HbA1c control, low-density lipoprotein cholesterol (LDL-C) screening, LDL-C control, retinopathy screening, nephropathy screening, and two measures of blood pressure control (less than 140/90 mm Hg and less than 130/80 mm Hg). For patients with hypertension, the authors assessed whether the HEDIS criterion for blood pressure control was met.

The authors found that the proportion of patients whose HEDIS measures improved ranged from 4.0 percent to 11.1 percent. In the matched-control analysis, secure communication was associated with an improvement of 2.4 to 6.5 percent in performance on HbA1c screening and control, LDL-C screening and control, retinopathy screening, and nephropathy screening. It was also associated with improved performance on blood pressure control (less than 140/90 mm Hg) among patients with diabetes and patients with hypertension alone. A 2.7-percent difference between pre- and post-performance in tighter blood pressure control (less than 130/80 mm Hg) among patients with diabetes achieved statistical significance at a lower level.

Among patients with hypertension alone, email users and nonusers achieved similar blood pressure control rates. The authors also found a dose-response effect. Compared to a single thread, two or more secure physician-patient email threads in a two-month period were associated with a greater likelihood of better performance on four measures: HbA1c, cholesterol screening, HbA1c control, and nephropathy screening.

The authors write that it is unclear how secure physician-patient communication might improve care, but possible mechanisms include increasing the continuity of care, physician-patient connectedness, and supporting patient self-management. Patients prefer this form of communication, however, and the authors write that “evidence is accumulating that secure patient-physician e-mail increases care efficiency.” The authors write that the current study results suggest that physician-patient email may help improve individual care experiences and the health of populations, as well as reduce per capita costs of care. They conclude that more “research is needed to confirm the potential of e-mail use as an important new modality for primary care.”

Source: Zhou YY, Kanter MH, Wang JJ, Garrido T. 2010. Improved quality at Kaiser Permanente through e-mail between physicians and patients. Health Affairs 7:1370-1375.