Secure messaging viable for diabetes support



MELBOURNE – Secure messaging can achieve similar outcomes in terms of behavioral goal achievement, self-reported health maintenance exam completion, and hemoglobin A1c level testing, compared with telephone and in-person support, new data suggest.

A study of different methods of diabetes self-management support found no significant differences in outcomes such as completion of foot and eye exams and HbA1c testing across the three follow-up methods at the 9-month follow-up, although there were some feasibility issues with the secure messaging service.

Ms. Deborah Greenwood

Presenter Deborah Greenwood told the World Diabetes Congress that the study arose out of a need to improve their ability to provide ongoing support for patients with type 2 diabetes.

"Because of the vast number of patients with diabetes, just trying to get people in for initial education is almost a barrier, so trying to add in ongoing support is a challenge," said Ms. Greenwood, diabetes program coordinator for the Sutter Health Integrated Diabetes Education Network.

Ms. Greenwood said the use of secure messaging was an attempt to tap into the so-called e-patient phenomenon: the growing number of patients who want to use online tools to help manage their disease.

The study recruited 146 patients with type 2 diabetes who had completed their diabetes education class at the clinic, and asked them to participate in a 9-month posteducation program via their choice of secure messaging, telephone, or the usual in-person follow-up.

Secure messages and telephone calls were timed at 3, 6, and 9 months, while the usual care involved an in-person follow-up between 3 and 6 months.

Secure message, via the clinic’s My Health Online personal health record system, proved the most popular patient choice, followed by in-person and then telephone follow-up.

However, there were significantly fewer successful contacts made via the secure messaging system. Researchers found that while 61% of subjects overall completed the intervention, only 44% of those in the secure message group completed it, compared with 71% of the in-person group and 75% of the telephone group.

When researchers did manage to engage with patients via the secure messaging system, they spent significantly less time with the patient than was spent in the other two groups.

Ms. Greenwood said while the secure message service was popular, it was more complex than a simple e-mail message, which may have contributed to the poor contact rates.

"They have to log into their account, they have to remember their password, so I think that was part of it," Ms. Greenwood said in an interview. She also suggested that the long gap between contacts may have played a role, and suggested that weekly contacts, at least initially, may have helped establish contact better.

Despite this, the online contact cost considerably less per participant ($27) than the telephone contact ($54) and the 1-hour in-person visit ($50).

Session chair Dr. Matthew Cohen, diabetes specialist at the Baker IDI Heart and Diabetes Institute, Melbourne, said telehealth solutions were really about convenience and patients avoiding having to travel to see a doctor.

"I think it’s becoming very popular, and [there is] a large group of younger patients who I think are going to expect to have access to medical care through e-mails and Skype and so on," Dr. Cohen said in an interview.

Although data from the telehealth studies did measure improvements in diabetes control, Dr. Cohen said there were huge advantages for patients, particularly for those who faced difficulties in getting to a doctor’s office.

Ms. Greenwood is on the board of the American Association of Diabetes Educators, which provided a grant for the study.

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