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Patients offered e-messaging visit, phone docs less

Patients who had access to their physicians via an electronic messaging service made fewer office visits than they did before enrolling in the service and fewer than members of a randomly selected control group of patients not enrolled in the Web-based message service, according to a recently published study by researchers with the Kaiser Permanente healthcare system.

The research also showed patients registered and using the service, part of a portal called KP HealthConnect online, apparently made fewer telephone calls to their physician’s office than members of the control group.

Results were published in an article, "Patient Access to an Electronic Health Record With Secure Messaging: Impact on Primary Care Utilization," in the July issue of the American Journal of Managed Care.

Kaiser researchers prepared two study groups. One, called the cohort study, involved 4,686 adult members of Kaiser Permanente Northwest region, which covers Oregon and southwest Washington state, who were registered for KP HealthConnect for more than 13 months and had used the service at least once. The other, called the matched-control study, took 3,201 members from the cohort study group and matched them with an equal number of Kaiser Permanente members with similar demographic and clinical profiles, but who were not registered with the messaging service.

The study period ran primarily between September 2002 and August 2005.

The key findings were:

  • Annual office visits of registered KP HealthConnect users in the cohort study declined 9.7%, from an average of 2.47 visits per member to 2.24 at a time when the overall number of visits in the region remained relatively "steady," according to study co-author Terhilda Garrido, executive director, strategic operations, quality and clinical systems support at Kaiser.
  • Within the matched-control study, annual office visits for registered KP HealthConnect users decreased 10.2% from an average of 2.44 per member to 2.19. In comparison, annual office visits for members of the control group not registered for online messaging dropped 3.7%, from an average of 2.15 per member to 2.07. Garrido said the researchers believe the drop in visits for the control group—even though the overall rate of visits in the region remained stable—might have been caused by heightened awareness and conscientiousness by physicians who knew they were part of a study group.
  • Identifying the impact of e-messaging on office phone calls was complicated by a change made in the way Kaiser counted telephone messages during the survey period. The change contributed to a 24% jump in phone calls across the district for all patients, but the call volume increase was significantly lower at 15.6% for members of the cohort study.
  • Within the matched-control group, phone contacts for registered KP Health Connect members rose 16.2% over the study period, from a mean of two calls per member, to 2.32. For matched-control group members not registered for the messaging service, the increase was 29.9%, from a mean of 1.74 calls per member to 2.26. Taking into consideration the "artificial bump" in call volume due to the change in the way Kaiser counted calls, for those using the KP HealthConnect technology "we were able to suppress this increase by 13.7" percentage points, Garrido said.
Garrido said a patient satisfaction survey found that Kaiser members liked the added convenience of e-messaging. "It's a big satisfier for the patients," she said. "This is what we're hearing from patients (that) this is not only helping me avoid an office visit, it's also helping me avoid phone calls," Garrido said. "It helps them feel better connected to their physicians."

Naturally, because Kaiser is an integrated delivery network, officials there can look upon technology driving a near-10% drop in office visits with far more equanimity than a fee-for-service physician group leader would.

"Hopefully, other kinds of payer groups will see there are advantages to the members and the payers overall," Garrido said. "They are experimenting with different kinds of reimbursement schemes to help make those physicians whole. I believe if members and patients are asking for it and physicians see it as a way of getting reimbursed properly, it's just a matter of working out the numbers."

Garrido said Kaiser researchers were somewhat surprised by who was using the e-messaging services most.

"One of the things we thought we'd see was that a lot of the younger and healthier members would want to use this, because they are more e-mail savvy. But it was the older folks, the 50 to 60 age group, these are the people with the highest propensity for chronic conditions" who "really seemed to jump at this," Garrido said. "They're used to having more touches, more interactions with their physicians and more on-going concerns. It seemed that they were taking more advantage of it."

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