scholarly journals Characteristics of Patients Using Different Patient Portal Functions and the Impact on Primary Care Service Utilization and Appointment Adherence (Preprint)

2019 ◽  
Author(s):  
Xiang Zhong ◽  
Jaeyoung Park ◽  
Muxuan Liang ◽  
Fangyun Shi ◽  
Pamela R. Budd ◽  
...  
Keyword(s):  
Primary Care ◽  
Service Utilization ◽  
Care Service ◽  
Office Visit ◽  
Health Problems ◽  
Primary Care Service ◽  
Patient Portal ◽  
Patient Portals ◽  
Appointment Adherence ◽  
The Impact

BACKGROUND Patient portals are now widely available and increasingly adopted by patients and providers. OBJECTIVE The objective of this study was to investigate the characteristics of primary care patients using different patient portal functions and the impact of patient portal usage on patients’ primary care service utilization and appointment adherence. METHODS A retrospective observational study using a large dataset of primary care patients of University of Florida (UF) Health was conducted. A total of 4312 patient portal users and 17580 nonusers were identified during the study period July 2013 – June 2016. Patients were classified into different user subgroups based on their portal usage of messaging, laboratory, appointment, and medication functions. The association between patient demographics and portal usage were analyzed. Primary care service utilization and appointment adherence were measured by primary care office visits arrived, no-show, cancellation, and telephone encounter rates per quarter. Generalized linear models (GLM) were built to compare the time-dependent portal usage effects across different user subgroups and nonusers. RESULTS Five different user subgroups based on their dominant portal activities and usage frequency were identified. After adopting portals, patients with fewer active health problems used portal infrequently (silent users). Medicare (P = 0.04), White, and age 46-64 (P = 0.01) and 65 and older (P = 0.04) were positively associated with messaging usage. Age 19-30 (P < 0.001) was positively associated with appointment usage, and gender female (P = 0.01) was positively associated with laboratory usage. On the impact of portal usage, disease burden adjusted rate ratios (RR) between user subgroups and nonusers were obtained. The office visit and telephone encounter RRs of users to nonusers were significantly larger than 1 right after portal adoption (with P values less than 0.05), but were not significantly different 2 years after adoption, except for the silent users, whose office visit and telephone encounter rates were significantly smaller after around 1 year post portal adoption (with P values less than 0.05). Office visit cancellation rates were not changed, and no-show rates were significantly reduced or at least not changed post portal adoption. Patients who used messaging and laboratory functions more often exhibited a larger reduction in no-show among other user subgroups. CONCLUSIONS Interestingly, a high propensity to adopt patient portals does not necessarily imply more frequent usage of portals. In particular, the number of active health problems was negatively associated with portal adoption but was positively associated with portal usage. For patients with fewer active health problems, their primary care service utilization was even lower after portal adoption; with a heavy disease burden, the utilization was temporarily increased but was not significantly changed after 2 years post adoption. Overall, appointment adherence was improved after portal adoption.

scholarly journals Characteristics of Patients Using Different Patient Portal Functions and the Impact on Primary Care Service Utilization and Appointment Adherence: Retrospective Observational Study

10.2196/14410 ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. e14410 ◽  
Author(s):  
Xiang Zhong ◽  
Jaeyoung Park ◽  
Muxuan Liang ◽  
Fangyun Shi ◽  
Pamela R Budd ◽  
...  
Keyword(s):  
Primary Care ◽  
Service Utilization ◽  
Care Delivery ◽  
Care Service ◽  
Primary Care Service ◽  
Patient Portal ◽  
Patient Portals ◽  
Appointment Adherence ◽  
Primary Care Patients ◽  
The Impact

Background Patient portals are now widely available and increasingly adopted by patients and providers. Despite the growing research interest in patient portal adoption, there is a lack of follow-up studies describing the following: whether patients use portals actively; how frequently they use distinct portal functions; and, consequently, what the effects of using them are, the understanding of which is paramount to maximizing the potential of patient portals to enhance care delivery. Objective To investigate the characteristics of primary care patients using different patient portal functions and the impact of various portal usage behaviors on patients’ primary care service utilization and appointment adherence. Methods A retrospective, observational study using a large dataset of 46,544 primary care patients from University of Florida Health was conducted. Patient portal users were defined as patients who adopted a portal, and adoption was defined as the status that a portal account was opened and kept activated during the study period. Then, users were further classified into different user subgroups based on their portal usage of messaging, laboratory, appointment, and medication functions. The intervention outcomes were the rates of primary care office visits categorized as arrived, telephone encounters, cancellations, and no-shows per quarter as the measures of primary care service utilization and appointment adherence. Generalized linear models with a panel difference-in-differences study design were then developed to estimate the rate ratios between the users and the matched nonusers of the four measurements with an observational window of up to 10 quarters after portal adoption. Results Interestingly, a high propensity to adopt patient portals does not necessarily imply more frequent use of portals. In particular, the number of active health problems one had was significantly negatively associated with portal adoption (odds ratios [ORs] 0.57-0.86, 95% CIs 0.51-0.94, all P<.001) but was positively associated with portal usage (ORs 1.37-1.76, 95% CIs 1.11-2.22, all P≤.01). The same was true for being enrolled in Medicare for portal adoption (OR 0.47, 95% CI 0.41-0.54, P<.001) and message usage (OR 1.44, 95% CI 1.03-2.03, P=.04). On the impact of portal usage, the effects were time-dependent and specific to the user subgroup. The most salient change was the improvement in appointment adherence, and patients who used messaging and laboratory functions more often exhibited a larger reduction in no-shows compared to other user subgroups. Conclusions Patients differ in their portal adoption and usage behaviors, and the portal usage effects are heterogeneous and dynamic. However, there exists a lack of match in the patient portal market where patients who benefit the most from patient portals are not active portal adopters. Our findings suggest that health care delivery planners and administrators should remove the barriers of adoption for the portal beneficiaries; in addition, they should incorporate the impact of portal usage into care coordination and workflow design, ultimately aligning patients’ and providers’ needs and functionalities to effectively deliver patient-centric care.

The Impact of Structured Laboratory Routines in Computerized Medical Records in a Primary Care Service Setting

2005 ◽  
Vol 29 (6) ◽  
pp. 619-626 ◽  
Author(s):  
Daniel A. Vardy ◽  
Tzachit Simon ◽  
Yehuda Limoni ◽  
Oded Kuperman ◽  
Ira Rabzon ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Records ◽  
Care Service ◽  
Primary Care Service ◽  
Service Setting ◽  
Computerized Medical Records ◽  
The Impact

scholarly journals Primary Care Service Utilization Among People at High Risk of Fatal Opioid Overdose: A Short Communication on an Autopsy Study

2020 ◽  
Vol 11 ◽  
pp. 215013272092595
Author(s):  
Matthew Jones ◽  
Ceri Bradshaw ◽  
Jenna Jones ◽  
Ann John ◽  
Helen Snooks ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Service Utilization ◽  
Care Service ◽  
Median Number ◽  
Primary Care Service ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Autopsy Study ◽  
Drug Dependent

Objectives: We sought to explore the sociodemographics and primary care service utilization among people who died from opioid overdose and to assess the possibility of using this information to identify those at high risk of opioid overdose using routine linked data. Methods: Data related to decedents of opioid overdose between January 1, 2012 and December 31, 2015 were linked with general practitioner (GP) records over a period of 36 months prior to death. Results: Of n = 312 decedents of opioid overdose, 73% were male (n = 228). Average age at death was 40.72 (SD 11.92) years. A total of 63.8% of the decedents were living in the 2 most deprived quintiles according to the Welsh Index of Multiple Deprivation. Over 80% (n = 258) of the decedents were recorded as having at least 1 GP episode during the 36-month observation period prior to death. The median number of episodes per decedent was 75 [38-118]. Overall, 31.8% (n = 82) of decedents with at least 1 GP episode received a prescription for a proton pump inhibitor and 31% (n = 80) were prescribed a broad-spectrum antibiotic. According to their GP records, less than 10% were referred to or receiving specialist drug treatment (n = 24, 9.3%); or were known to be drug dependent (n = 21, 8.14%), or a drug user (n = 5, 1.94%). In all, 81% were recorded as smokers (n = 209) and 10.5% as ex-smokers (n = 27). Conclusions: The majority of decedents of opioid overdose were in contact with GP services prior to death. GPs are either often unaware of high-risk opioid use, or rarely record details of opioid use in patient notes. It is possible that GP awareness of high-risk opioid use could be increased. For example, awareness of the risks associated with opioid use, and the relationship between the sociodemographic and clinical characteristics of opioid overdose decedents could be raised using educational materials prominently displayed in waiting areas. Clinicians in primary care may be in an excellent position to intervene in problematic opioid use.

scholarly journals Enhanced Primary Care improves GP service regularity in older patients without impacting on service frequency

2012 ◽  
Vol 18 (4) ◽  
pp. 295 ◽  
Author(s):  
David A. J. Gibson ◽  
Rachael E. Moorin ◽  
David Preen ◽  
Jon Emery ◽  
C. D'Arcy J. Holman
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Multinomial Logistic Regression ◽  
Care Service ◽  
Primary Care Service ◽  
Service Utilisation ◽  
Relative Likelihood ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

The objective of this study was to assess the impact of Enhanced Primary Care service utilisation on subsequent GP service regularity and frequency. The study involved a retrospective population-based longitudinal cohort using linked administrative health records of hospital and primary care services for people over the age of 65 years. Multinomial logistic regression modelling was used to evaluate changes in the relative likelihood of increased primary care service regularity and frequency in exposed and unexposed individuals adjusting for age, sex and recent chronic disease hospitalisation history. Enhanced Primary Care services significantly and substantially increased the relative likelihood of increased regularity with no corresponding higher likelihood of increased frequency of GP contact. Increased regularity was more likely with increasing age except for the oldest age group (90+ years). Some chronic disease histories (e.g. diabetes) showed a higher likelihood of improved regularity while others were less likely to produce an increased regularity (e.g. hypertension). The study suggests a capacity for modification of physician and patient behaviour using incentivised services within the current fee-for-service system in Australia.

scholarly journals Do socially complex patients seek primary care from clinics specifically designed to meet their needs?

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Alan Katz ◽  
Dan Chateau ◽  
Carole Taylor ◽  
Jeff Valdivia
Keyword(s):  
Primary Care ◽  
Population Health ◽  
Social Complexity ◽  
Care Service ◽  
Primary Care Service ◽  
Income Quintile ◽  
Care Providers ◽  
Social Data ◽  
Children In Care ◽  
The Impact

ABSTRACTObjectivesTo determine the relationship between known social complexity and model of primary care service deliveryApproachThe impacts of the social determinants of health are well described. To understand the contribution of specific factors on primary care service use we linked social data in the Population Health Research Data Repository at the Manitoba Centre for Health Policy to health system data. We included all patients visiting a Winnipeg clinic at least three times between 2010 and 2013. We allocated each participant to the primary care provider providing the majority of their care; and each provider was assigned to the model of care where they provided the majority of their clinical care. We developed eleven new indicators to describe social complexity such as: children in care, low income quintile, income assistance (welfare), high residential mobility, and involvement with the justice system. Results The cohort included 626,264 unique individuals of whom 53.1% were female. The majority of participants received their care from the fee for service (FFS) model (511,763) followed by 76,261 assigned to “reformed FFS”. 16,536 and 12,178 were assigned to the 2 team-based care alternative funded models and 9,526 to the teaching clinic model. Patients with social complexities, except for newcomers, were more likely to attend the alternative funded clinics. The patients these clinics served were generally very complex with over 15% having more than 5 complexities compared to less than 5% of those attending the FFS models. Twice as many patients in the FFS models (60%) had no complexities compared to the alternative funded models.ConclusionThe availability of social data in population health repositories provides new opportunities to understand the distribution of these social factors amongst care providers and the impact of each on the health of populations. This new understanding can support focused interventions to address specific social risk factors and provide the evidence to support different models of primary care service delivery.

scholarly journals A national evaluation of the Irish public health counselling in primary care service– examination of initial effectiveness data

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charles Brand ◽  
Fiona Ward ◽  
Niamh MacDonagh ◽  
Sharon Cunningham ◽  
Ladislav Timulak
Keyword(s):  
Primary Care ◽  
Large Scale ◽  
Care Service ◽  
Outcome Data ◽  
Primary Care Service ◽  
Observational Research ◽  
Research Approach ◽  
Growth Curve Analysis ◽  
Republic Of Ireland ◽  
Post Therapy

Abstract Background The Counselling in Primary Care service (CIPC) is the first and only nationally available public counselling service in the Republic of Ireland. This study provides initial data for the effectiveness of short-term psychotherapy delivered in a primary care setting in Ireland for the first time. Method A practice-based observational research approach was employed to examine outcome data from 2806 clients receiving therapy from 130 therapists spread over 150 primary care locations throughout Ireland. Pre-post outcomes were assessed using the CORE-OM and reliable and clinically significant change proportions. Binary logistic regression examined the effect of pre therapy symptom severity on the log odds of recovering. Six and 12 month follow up data from a subsample of 276 clients were also analysed using growth curve analysis. Results Of 14,156 referred clients, 5356 presented for assessment and 52.3% (N = 2806) consented to participate. Between assessment and post-therapy a large reduction in severity of symptoms was observed- Cohen’s d = 0.98. Furthermore, 47% of clients achieved recovery,a further 15.5% reliably improved, 2.7% reliably deteriorated and34.7% showed no reliable improvement. Higher initial severity was associated with less chance of recovering at post-therapy. Significant gains were maintained between assessment and12 months after therapy- Cohen’s d = 0.50. Conclusions Outcomes for clients in the CIPC service compared favourably with large scale counselling and psychotherapy services in jurisdictions in the U.K., the U.S.A., Norway and Sweden. This study expands the international primary care psychotherapy research base to include the entire Republic of Ireland jurisdiction.

scholarly journals Providing a primary care service for psychiatric in-patients

2004 ◽  
Vol 28 (5) ◽  
pp. 167-170 ◽  
Author(s):  
Enone Welthagen ◽  
Sarah Talbot ◽  
Oliver Harrison ◽  
Michael Phelan
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Psychiatric Care ◽  
Care Service ◽  
Primary Care Service ◽  
Clinical Implications ◽  
Model Of Care ◽  
Wide Range ◽  
Set Up ◽  
Acute Psychiatric Care

Aims and MethodA prospective descriptive study was set up to evaluate the feasibility, acceptability and activity of an innovative weekly primary care service for patients admitted for acute psychiatric care.ResultsDuring 10 months, 36 clinics were held and 123 appointments were attended. Presenting complaints included a wide range of acute and chronic conditions, affecting all body systems. As well as treating specific complaints, the doctor providing this service undertook considerable health promotion work and gave advice about patient management to junior psychiatrists.Clinical ImplicationsIt appears that there is considerable need for primary care expertise within an acute psychiatric unit, and that a weekly clinic is a feasible model of care.

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