An exploration of the potential for patient portals to improve self- management. Presented by Kim Letford, School of Population Health, University of Auckland, at HINZ 2014, 11 November 2014, 12.22pm, Plenary Room

1. An exploration of the potential for
patient portals to improve self-management
of long-term
conditions
Kim Letford

2. Self-management
Improving the health of people with long-term
conditions, while reducing the load on health
systems. Requires*:
O Knowledge of the condition and its
management
O Care plan agreed with care team, shared
decision making
O Managing the disease’s symptoms and the
impact on daily functioning
O Adopting lifestyles that address risk factors
O Being able to use support services
*Australian National Chronic Disease Strategy, 2005

3. The NSCP programme’s
patient portal

4. How data was gathered
1. Web-based survey
O emailed to all 59 patients registered with the
NSCP Programme portal
O Fifteen respondents (25% response rate)
O Of the fifteen, nine had ever logged into the
portal
2. Semi structured interviews
O Seven of the nine were interviewed in their
homes.
O Participants 60 to 80 years old, five men and
two women, six European and one Indian
ethnicity

5. What motivated patients to
use the portal?
1. “Perceived ease of use*” – not found to be a
barrier with the NSCP Programme Portal
2. “Perceived usefulness*” – mostly from how
much the care team engaged with the
patient via the portal and transactional
functionality, eg ordering prescriptions online
Theme of patients not perceiving the portal to be
very useful, or of greater value than what they
otherwise had access to
*From Davis’ Technology Acceptance Model, 1989

6. Where the portal was useful
Secure messaging with care teams was the biggest
source of value:
O Asynchronous communication, an efficient way to
share information with busy clinicians
O Improved access to the care team, particularly expert
advice from specialists
O Reassurance that a doctor or nurse was monitoring
health status
However,
O No doctors were using the portal
O Nurses were using it inconsistently
O No care plans were in active use
O Care teams were not using all of the portal’s
functions

7. Where the portal was useful
(continued)
O Monitoring and managing the signs and symptoms
of their condition
O A record of interactions, for reference and
reinforcement of what was already decided. (But
patients wanted to discuss anything important
during appointments)
O Potential for getting information on their illness and
its management, especially when first diagnosed
(However, no patients had been given this
information)

8. The portal’s overall influence
on self-management
O Overall, the patients felt that the portal was not
strongly influencing their self-management
O Good self-management mostly seen as being
achieved through self-efficacy and with support
from friends, family and care teams
O Low levels of engagement by care teams reduced
the portal’s potential to influence self-management

9. Implications of this study:
what next?
O Explore the barriers to care teams using
patient portals. Their engagement impacts
significantly on whether patients use them
and find them useful
O Carefully consider what can be achieved
using patient portals - they are a tool to
support self-management programmes,
rather than the complete solution.