Background and Goal: Use of secure messaging, which lets patients communicate with clinicians or care teams through an online portal, has increased in recent years. While secure messaging can increase access to care, answering a high volume of messages can burden care teams. Researchers examined the percentage of all secure messages that were exchanged between primary care teams and high users and whether high users were also heavy users of other primary care or emergency department services.
Study approach: Researchers analyzed data from the VHA Corporate Data Warehouse, the Patient-Centered Management Module web application and the My HealtheVet portal. They included every veteran who sent or received at least one secure message with primary care during a one-year study period from October 1, 2022 to September 30, 2023. Veterans at or above the 95th percentile of annual message volume were classified as high users.
Main Results: Over 1.5 millions veterans were included in the analysis.
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High users exchanged 30.5% of all secure messages. High user exchanges featured a greater percentage of patient-generated messages.
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Veterans were more likely to be high users if they were aged 75 years or older, were more frail, had higher degrees of complexity, or lived with mental-health conditions. They were also more likely to be White individuals and to live in neighborhoods with higher socioeconomic status.
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Most secure-messaging high users did not use in-person, telephone, video, or emergency care services at the same high frequency as secure messages.
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Patients were less likely to be high users if they identified as Black, Hispanic, or Asian/Pacific Islander/Native Hawaiian, or were male.
Why It Matters: These findings can help family physicians and policy makers focus outreach and resources on patient subgroups that rely heavily on secure messaging. The results can also help practice leaders anticipate which veterans’ access might be most affected by policy changes.
High Users of Primary Care Secure Messaging in the Veterans Health Administration
Jonathan Staloff, MD, MSc, et al
Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
Department of Family Medicine, University of Washington, Seattle, Washington
Journal
The Annals of Family Medicine