The Next Step: Achieving Health Behavior Change Through Technology.
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Transcript of The Next Step: Achieving Health Behavior Change Through Technology.
Research Questions• RWJ: RFP to evaluate patient portals (MyGeisinger)• For patients with chronic conditions (DM, CVD,
CHF), do e-health interventions influence:– Measures of:
• patient activation• patient self-management• treatment adherence• patient satisfaction with care• disease specific knowledge
– Process measures of appropriate CVD/DM/CHF care• HbA1c, LDL tests• Prescribed meds
– Clinical markers of cardiovascular/DM morbidity & risk• SBP, HbA1c, LDL
Intervention
• Web-based health behavior change program– Care For Your Health (HealthMedia, Inc)
• Objective:– create “expert patients” with the confidence, skills, and knowledge to
self-manage• Method:
– Patient completes initial assessment online (~80 items)– Customized “plan” that helps patients focus on:
• acceptance of condition• communication with providers• lifestyle choices• goal setting• medication/treatment adherence• planning skills
– Visit the site initially to complete assessment, return to review plan and use additional tools
Study DesignGeisinger Patients with Geisinger Clinic
primary care provider
Portal Usersn = 3,297
Non-Portal Usersn = 29,600
Intervention Groupn = 1,649
Control Groupn = 1,648
Non-Portal Usersn = 1,649
Matched selection
Diagnosisof: CVD, DM,
or CHF?
Randomize
Exclude
Registered MyGeisinger
User?
Yes
No
Yes No
Recruitment Model• First phase:
– Initial letter from director of Geisinger’s ambulatory clinics• Follow-up letters (2)• Follow-up emails (2)
• Second phase:– Letter from PCP
• Follow-up PCP letter (2)• Follow-up PCP email (2)
• Letter content: – General info about the study and intervention– Instructions on how to log into MyGeisinger & click the
link to Care For Your Health
Results: Overall• Primary Endpoints (6 and 12 month f/u):
– No effect on process measures• No difference in rates of appropriate testing (e.g. A1c,
foot exams) or appropriate use of medications (e.g. ACE-I for CHF)
– No effect on clinical measures• No difference in SBP, DBP, LDL, Total Chol, A1c
– No effect on patient-reported outcomes• Patient activation, adherence, satisfaction
What happened?
• Enrollment problems:– Only 247 (~) 17%patients enrolled in CFYH
• Were patients unaware of the intervention?– Interim survey
• Are patients just not interested in e-health?– Analysis of MyGeisinger vs. HMI use
Results: Interim Phone Survey• Surveyed 30 random non-enrollees to identify
reasons for non-enrollment (~11%)• Findings:
– 90% use the Internet at least once per week – 100% recalled receiving the invitation letter
• 67% did not recognize the physician signing the letter• 42% said recognizing physician mattered
– 47% - wanted more information– 67% - technical problems
• Conclusion: – they know about the intervention
Results: MyGeisinger Use• Analyzed 12 months of MyGeisinger use
– Analyzed log files• Results:
– 86% used the Internet for at least 3 sessions during the 12-month period
– Most popular functions:• Lab results, Messaging, Proxy access
– Clear presence of user “clusters”• Portal use for specific purposes: Proxy users, lab trackers,
appointment “preppers”, etc.
• Conclusions:– Patients like, and actively use, electronic tools for health-
related purposes
Conclusions• Study participants WERE aware of and using “e-health”
“E-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies.”
– Eysenbach, J Med Internet Res 2001
• There is a fundamental difference in the process of engaging patient in accessing information (i.e. EHR, lab data) vs. health behavior change– Immediate gratification vs. long-term health
Conclusions (cont’d)• “Simple” solutions:
– Need to make it simple for patients– Patients need better information
• The primary care physician is important
• Complex solutions– Not all e-health is created equal…
• Accessing data vs. behavior change– Health behavior change is difficult on the web, just as it
is in a paper-based world– If you build it, “they” won’t necessarily come– Who are “they”
• Need to understand who, why, how to develop better approaches to engaging patients
Future Research
• Understanding patient engagement and activation– Eysenbach (2001) – the law of “attrition”
• Important, but how do we engage them (non-early adopters) in the first place?
• Current studies– “Risk-informed engagement”
• eCVD-II• eAspirin
Pictures