Care Partner Engagement in Secure Messaging Between Patients With Diabetes and Their Clinicians: Cohort Study

• Published in: JMIR diabetes 2024-02, Vol.9, p.e49491
• Main Authors: Semere, Wagahta, Karter, Andrew J, Lyles, Courtney R, Reed, Mary E, Karliner, Leah, Kaplan, Celia, Liu, Jennifer Y, Livaudais-Toman, Jennifer, Schillinger, Dean
• Format: Article
• Language: English
• Subjects: Algorithms; Chronic illnesses; Communication; Diabetes; Educational attainment; Electronic health records; Health care delivery; Health education; Health literacy; Integrated delivery systems; Linguistics; Patient compliance; Patient satisfaction; Personal health; Proxies; Sociodemographics; Telemedicine; Web portals
• ISSN: 2371-4379; 2371-4379
• DOI: 10.2196/49491

Patient engagement with secure messaging (SM) via digital patient portals has been associated with improved diabetes outcomes, including increased patient satisfaction and better glycemic control. Yet, disparities in SM uptake exist among older patients and racial and ethnic underserved groups. Care partners (family members or friends) may provide a means for mitigating these disparities; however, it remains unclear whether and to what extent care partners might enhance SM use. We aim to examine whether SM use differs among older patients with diabetes based on the involvement of care partner proxies. This is a substudy of the ECLIPPSE (Employing Computational Linguistics to Improve Patient-Provider Secure Emails) project, a cohort study taking place in a large, fully integrated health care delivery system with an established digital patient portal serving over 4 million patients. Participants included patients with type 2 diabetes aged ≥50 years, newly registered on the patient portal, who sent ≥1 English-language message to their clinician between July 1, 2006, and December 31, 2015. Proxy SM was identified by having a registered proxy. To identify nonregistered proxies, a computational linguistics algorithm was applied to detect words and phrases more likely to appear in proxy messages compared to patient-authored messages. The primary outcome was the annual volume of secure messages (sent or received); secondary outcomes were the length of time to the first SM sent by patient or proxy and the number of annual SM exchanges (unique message topics generating ≥1 reply). The mean age of the cohort (N=7659) at this study's start was 61 (SD 7.16) years; 75% (n=5573) were married, 15% (n=1089) identified as Black, 10% (n=747) Chinese, 12% (n=905) Filipino, 13% (n=999) Latino, and 30% (n=2225) White. Further, 49% (n=3782) of patients used a proxy to some extent. Compared to nonproxy users, proxy users were older (P