Diabetes Mellitus
Conditions
Keywords
Diabetes Mellitus, Personal Health Records, Patient Outcome Assessment, Mental Health
Brief summary
Patient-facing eHealth technologies, such as online patient portals, connect patients with the healthcare system, help them access their health information, and support self-management of health conditions. This study tested an intervention to improve adoption and use of the My HealtheVet patient portal for diabetes management.
Detailed description
The goal of this small scale study is to test the feasibility of engaging Veterans in a supported adoption intervention to promote effective patient portal use in a sample of Veterans with uncontrolled Type II diabetes. Participants were eligible for recruitment if they were Veterans age 18-85 who were actively receiving care at one of the study sites (as determined by having an upcoming scheduled appointment), had uncontrolled glucose (HbA1c \>= 8.5%), and had either never used the VA patient portal or were inactive registrants who have not used the patient portal in the past 12 months. Participants who met these conditions and did not opt out of the study were randomized to one of four arms: 1) Encouragement I (brochure + mailed training guide), 2) Encouragement II (brochure + mailed training guide + invitation to group training), 3) Encouragement III (brochure + mailed training guide + invitation to group and one-on-one training), and 4) Comparison (standard patient portal enrollment brochure only). All arms received the standard My HealtheVet patient portal enrollment brochure along with an invitation to participate in the study. Those randomized to any of the Encouragement Arms received a mailed training guide. The My HealtheVet Training Guide for Veterans Living with Diabetes was designed in conjunction with Veteran co-investigators based on feedback from patients living with diabetes who were My HealtheVet users. It provided step by step guidance on how to use the features Veterans living with diabetes find most helpful with specific examples of use for diabetes self-management. Those in Encouragement Arm II were also invited to attend one of several group training sessions. Those in Encouragement III were invited to schedule a one-on one session to learn how to use the patient portal. Those in the comparison condition were asked during their interview if they would like a Training Guide mailed to them at the end of the trial, and those interested were mailed a Training Guide.
Interventions
BEHAVIORALMy HealtheVet Training Guide for Veterans Living with Diabetes
Participants will be mailed a bound My HealtheVet training guide with step by step instructions on how to register, upgrade to Premium account, refill prescriptions, use secure messaging, download their Blue Button reports, and other features
BEHAVIORALMy HealtheVet Brochure
Participants will receive a mailed brochure with basic My HealtheVet content.
BEHAVIORALMy HealtheVet Group Training
Participants will be invited to participate in a scheduled group training to learn how to use My HealtheVet to help manage their diabetes
BEHAVIORALMy HealtheVet Individual Training
Participants will be invited to participate in a one-on-one training to learn how to use My HealtheVet to help manage their diabetes at a time of their convenience.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Masking description
Participants were not explicitly told which group they were randomized to
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Veterans * Hemoglobin A1c result \>=8.5% at most recent lab test prior to recruitment * Non use of the VA patient portal, defined by not being registered or registered with no activity in 12 months * Currently being seen at one of the sites participating in the study (upcoming appointment scheduled)
Exclusion criteria
* Non-Veterans * Controlled hemoglobin A1c levels (A1c\<8.5%) at most recent lab test prior to recruitment * Recent use of the patient portal
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Any My HealtheVet Patient Portal Use | Portal use within 180 days of initial brochure mailing | This measure captures any use of MHV within 180 days of the brochure mailing, including use of prescription refills, secure messaging, Blue Button, or any other portal features. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Upgraded to a Premium My HealtheVet Portal Account | 180 days from brochure mailing | After registering for the portal, patients must confirm their identity and accept the terms and conditions of the portal in order to upgrade to Premium status which allows access to secure messaging, their VA appointments, and electronic health record extracts such as lab results, medical imaging and reports, clinical notes, and their VA health summary. Patients can access a limited subset of portal features, including online prescription refills, without upgrading to Premium. This measure captures whether a participant upgraded to a Premium account during the trial. |
| Use of Online Prescription Refills | 180 days from brochure mailing | This measure captures whether the participant used the portal's online prescription refill feature at least once within 180 days of mailing the brochure. |
| Use of Secure Messaging | 180 days from brochure mailing | Patient used the secure messaging feature during the trial |
Countries
United States
Participant flow
Recruitment details
Patients meeting eligibility criteria were identified from clinical records and mailed an invitation to participate in the study along with a My HealtheVet brochure and an information sheet describing the study. Initial invitations were sent out in June 2019 at Site 1 and in December 2019 at Site 2. Patients who did not opt out were enrolled and randomized into study arms in July 2019 and January 2020, respectively.
Pre-assignment details
One patient was mistakenly randomized to an arm even though he was deceased shortly prior to enrollment because he met the eligibility criteria according to our databases, including having a future appointment scheduled. Fifteen patients from one site were incorrectly identified as not having used the portal in the 12 months prior to the trial and were excluded from the analyses.
Participants by arm
| Arm | Count |
|---|---|
| Brochure Only Comparison Arm The comparison condition only received a mailed brochure with basic My HealtheVet content during the trial.
After the completion of their telephone interview, they were offered a copy of the training guide. | 65 |
| Encouragement Arm 1 Participants in this encouragement condition received a brochure about the My HealtheVet portal and were also mailed a training guide with (a) insights from other Veterans on how to use My HealtheVet for diabetes self-management, (b) step-by-step guidance for how to sign up for My HealtheVet and, (c) detailed guidance on how to learn to use key features. | 63 |
| Encouragement Arm 2 Participants in this encouragement condition received the My HealtheVet brochure and training guide, but were also offered optional attendance at one of several group training sessions. | 65 |
| Encouragement Arm 3 Participants in this encouragement condition received the same encouragement as in Arm 2 (brochure, training guide and group training offer) but were also offered a one-on-one My HealtheVet training session. | 67 |
| Total | 260 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Used portal during 6 months prior to randomization | 3 | 6 | 3 | 3 |
Baseline characteristics
| Characteristic | Encouragement Arm 1 | Total | Encouragement Arm 3 | Brochure Only Comparison Arm | Encouragement Arm 2 |
|---|---|---|---|---|---|
| Age, Continuous | 68.3 years STANDARD_DEVIATION 8.8 | 68.7 years STANDARD_DEVIATION 9.2 | 70.0 years STANDARD_DEVIATION 9.1 | 67.7 years STANDARD_DEVIATION 10.3 | 68.5 years STANDARD_DEVIATION 8.8 |
| Average HbA1c at baseline (2019) | 9.3 % (DCCT units) STANDARD_DEVIATION 1 | 9.4 % (DCCT units) STANDARD_DEVIATION 1.2 | 9.3 % (DCCT units) STANDARD_DEVIATION 1.1 | 9.6 % (DCCT units) STANDARD_DEVIATION 1.3 | 9.5 % (DCCT units) STANDARD_DEVIATION 1.3 |
| Marital Status Divorced/Separated | 14 Participants | 75 Participants | 18 Participants | 19 Participants | 24 Participants |
| Marital Status Married | 30 Participants | 125 Participants | 34 Participants | 30 Participants | 31 Participants |
| Marital Status Single | 15 Participants | 44 Participants | 12 Participants | 12 Participants | 5 Participants |
| Marital Status Widowed | 4 Participants | 16 Participants | 3 Participants | 4 Participants | 5 Participants |
| Race/Ethnicity, Customized Black/African-American | 6 Participants | 20 Participants | 5 Participants | 5 Participants | 4 Participants |
| Race/Ethnicity, Customized Latino | 5 Participants | 13 Participants | 0 Participants | 4 Participants | 4 Participants |
| Race/Ethnicity, Customized Other | 1 Participants | 3 Participants | 2 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Unknown/Missing | 4 Participants | 11 Participants | 5 Participants | 2 Participants | 0 Participants |
| Race/Ethnicity, Customized White | 47 Participants | 213 Participants | 55 Participants | 54 Participants | 57 Participants |
| Region of Enrollment United States | 63 Participants | 260 Participants | 67 Participants | 65 Participants | 65 Participants |
| Rural Residence | 2 Participants | 7 Participants | 2 Participants | 0 Participants | 3 Participants |
| Sex: Female, Male Female | 1 Participants | 5 Participants | 0 Participants | 2 Participants | 2 Participants |
| Sex: Female, Male Male | 62 Participants | 255 Participants | 67 Participants | 63 Participants | 63 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 1 / 68 | 0 / 69 | 4 / 68 | 0 / 70 |
| other Total, other adverse events | 0 / 68 | 0 / 69 | 0 / 68 | 0 / 70 |
| serious Total, serious adverse events | 0 / 68 | 0 / 69 | 0 / 68 | 0 / 70 |
Outcome results
Primary
Any My HealtheVet Patient Portal Use
This measure captures any use of MHV within 180 days of the brochure mailing, including use of prescription refills, secure messaging, Blue Button, or any other portal features.
Time frame: Portal use within 180 days of initial brochure mailing
Population: Patients randomized to each arm who had not used My HealtheVet in the 12 months prior to randomization. At the second site, 15 people who should have been excluded were inadvertently included in the sample because the criteria of no secure messaging use in previous 12 months was mistakenly used instead of no patient portal use in the previous 12 months. We did not discover this until after the trial was complete because there were delays in receiving actual portal use data.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Brochure Only Comparison Arm | Any My HealtheVet Patient Portal Use | 6 Participants |
| Encouragement Arm 1 | Any My HealtheVet Patient Portal Use | 1 Participants |
| Encouragement Arm 2 | Any My HealtheVet Patient Portal Use | 5 Participants |
| Encouragement Arm 3 | Any My HealtheVet Patient Portal Use | 8 Participants |
p-value: 0.057Chi-squared
p-value: 0.753Chi-squared
p-value: 0.613Chi-squared
Secondary
Patient Upgraded to a Premium My HealtheVet Portal Account
After registering for the portal, patients must confirm their identity and accept the terms and conditions of the portal in order to upgrade to Premium status which allows access to secure messaging, their VA appointments, and electronic health record extracts such as lab results, medical imaging and reports, clinical notes, and their VA health summary. Patients can access a limited subset of portal features, including online prescription refills, without upgrading to Premium. This measure captures whether a participant upgraded to a Premium account during the trial.
Time frame: 180 days from brochure mailing
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Brochure Only Comparison Arm | Patient Upgraded to a Premium My HealtheVet Portal Account | 0 Participants |
| Encouragement Arm 1 | Patient Upgraded to a Premium My HealtheVet Portal Account | 1 Participants |
| Encouragement Arm 2 | Patient Upgraded to a Premium My HealtheVet Portal Account | 2 Participants |
| Encouragement Arm 3 | Patient Upgraded to a Premium My HealtheVet Portal Account | 5 Participants |
p-value: 0.308Chi-squared
p-value: 0.154Chi-squared
p-value: 0.025Chi-squared
Secondary
Use of Online Prescription Refills
This measure captures whether the participant used the portal's online prescription refill feature at least once within 180 days of mailing the brochure.
Time frame: 180 days from brochure mailing
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Brochure Only Comparison Arm | Use of Online Prescription Refills | 5 Participants |
| Encouragement Arm 1 | Use of Online Prescription Refills | 1 Participants |
| Encouragement Arm 2 | Use of Online Prescription Refills | 0 Participants |
| Encouragement Arm 3 | Use of Online Prescription Refills | 3 Participants |
p-value: 0.102Chi-squared
p-value: 0.023Chi-squared
p-value: 0.439Chi-squared
Secondary
Use of Secure Messaging
Patient used the secure messaging feature during the trial
Time frame: 180 days from brochure mailing
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Brochure Only Comparison Arm | Use of Secure Messaging | 1 Participants |
| Encouragement Arm 1 | Use of Secure Messaging | 1 Participants |
| Encouragement Arm 2 | Use of Secure Messaging | 2 Participants |
| Encouragement Arm 3 | Use of Secure Messaging | 7 Participants |
p-value: 0.982Chi-squared
p-value: 0.559Chi-squared
p-value: 0.032Chi-squared