Public Release:  Personal health record associated with improved medication adherence

Patients also saw improved cholesterol levels

Kaiser Permanente

OAKLAND, Calif. -- Patients with diabetes who used an online patient portal to refill medications increased their medication adherence and improved their cholesterol levels, according to a new study in the journal Medical Care.

Online patient portals allow users to perform tasks such as scheduling appointments, accessing their health records, viewing their lab test results and emailing their care providers in addition to ordering prescription refills.

The study followed 17,760 patients with diabetes who received care from Kaiser Permanente in Northern California between January 2006 and December 2010.

Medication non-adherence and poorly controlled cholesterol declined by 6 percent among exclusive users compared to the occasional users or non-users of the online refill function.

In this large sample of patients with diabetes, the average age was 62, and 40 percent were non-white minorities. The patients studied had an average of more than six chronically used medications and 11 outpatient visits per year.

"Medication adherence and other health behaviors are often the hardest things for a health care system to influence," said senior author Andrew J. Karter, PhD, research scientist at the Kaiser Permanente Division of Research in Oakland, Calif. "Offering patients the option of ordering prescription refills online may create efficiencies for pharmacy operations, convenience for patients, and also improvements in adherence and health."

All patients were registered users of Kaiser Permanente's personal health record, My Health Manager, and had been prescribed cholesterol-lowering medications. The study subjects were divided into three groups based on their use of the portal to order refills of their cholesterol-lowering medications: the control group included those who never used the online refill function; "occasional users," who requested medication refills through the Kaiser Permanente patient portal at least once (but not always); and "exclusive users" who requested all of their refills through the patient portal. The cholesterol-lowering medications studied are widely prescribed for patients with diabetes.

"This research is an important step in understanding the benefits of portals beyond convenience," said lead author Urmimala Sarkar, MD, an assistant professor at University of California San Francisco. "Given the clear connection between medication adherence and improved health outcomes, this study provides insight into how online portals may improve health outcomes."

Internet-based patient portals, as well as the use of electronic medical records, are becoming increasingly important to health care delivery. The current study provides new evidence that patient portals may help patients adhere to their medications and achieve improved health outcomes.

This study is part of Kaiser Permanente's work to better understand how online patient portals can improve care. Earlier this year Kaiser Permanente researchers found that the use of electronic health records in clinical settings was associated with a decrease in emergency-room visits and hospitalizations for patients with diabetes.

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Kaiser Permanente can conduct transformational health research such as this study in part because it has the largest private patient-centered electronic health system in the world. The organization's electronic health record system, Kaiser Permanente HealthConnect®, securely connects 9.1 million patients to 16,000 physicians in more than 600 medical offices and 38 hospitals. It also connects Kaiser Permanente's research scientists to one of the most extensive collections of longitudinal medical data available, facilitating studies and important medical discoveries that shape the future of health and care delivery for patients and the medical community.

Additional authors included on the study are Courtney R. Lyles, PhD, and Dean Schillinger, MD, of the UCSF Division of General Internal Medicine, San Francisco General Hospital; Melissa M. Parker MPH, and Howard H. Moffet, MPH, of the Division of Research, Kaiser Permanente Northern California; and Jill Allen, PhD, and Robert Nguyen, MA, of the Kaiser Foundation Health Plan, Internet Services Group.

Funding sources include the National Institutes of Health (R01-DK080726, R01-DK081796).

About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, the Division's 550+ staff are working on more than 350 ongoing research studies in behavioral health and aging, cancer, cardiovascular and metabolic conditions, health care delivery and policy, infectious diseases, vaccine safety and effectiveness, and women's and children's health.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 9.1 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to kp.org/share.

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