Patient portal messaging to address delayed follow-up for uncontrolled diabetes: a pragmatic, randomised clinical trial.

Abstract

Importance: Patients with poor glycaemic control have a high risk for major cardiovascular events. Improving glycaemic monitoring in patients with diabetes can improve morbidity and mortality.

Objective: To assess the effectiveness of a patient portal message in prompting patients with poorly controlled diabetes without a recent glycated haemoglobin (HbA1c) result to have their HbA1c repeated.

Design: A pragmatic, randomised clinical trial.

Setting: A large academic health system consisting of over 350 ambulatory practices.

Participants: Patients who had an HbA1c greater than 10% who had not had a repeat HbA1c in the prior 6 months.

Exposures: A single electronic health record (EHR)-based patient portal message to prompt patients to have a repeat HbA1c test versus usual care.

Main outcomes: The primary outcome was a follow-up HbA1c test result within 90 days of randomisation.

Results: The study included 2573 patients with a mean (SD) HbA1c of 11.2%. Among 1317 patients in the intervention group, 24.2% had follow-up HbA1c tests completed within 90 days, versus 21.1% of 1256 patients in the control group (p=0.07). Patients in the intervention group were more likely to log into the patient portal within 60 days as compared with the control group (61.2% vs 52.3%, p<0.001).

Conclusions: Among patients with poorly controlled diabetes and no recent HbA1c result, a brief patient portal message did not significantly increase follow-up testing but did increase patient engagement with the patient portal. Automated patient messages could be considered as a part of multipronged efforts to involve patients in their diabetes care.