Randomized controlled trial of health maintenance reminders provided directly to patients through an electronic PHR

Abstract

Background: Provider and patient reminders can be effective in increasing rates of preventive screenings and vaccinations. However, the effect of patient-directed electronic reminders is understudied.

Objective: To determine whether providing reminders directly to patients via an electronic Personal Health Record (PHR) improved adherence to care recommendations.

Design: We conducted a cluster randomized trial without blinding from 2005 to 2007 at 11 primary care practices in the Partners HealthCare system.

Participants: A total of 21,533 patients with access to a PHR were invited to the study, and 3,979 (18.5%) consented to enroll.

Interventions: Patients in the intervention arm received health maintenance (HM) reminders via a secure PHR "eJournal," which allowed them to review and update HM and family history information. Patients in the active control arm received access to an eJournal that allowed them to input and review information related to medications, allergies and diabetes management.

Main measures: The primary outcome measure was adherence to guideline-based care recommendations.

Key results: Intention-to-treat analysis showed that patients in the intervention arm were significantly more likely to receive mammography (48.6% vs 29.5%, p = 0.006) and influenza vaccinations (22.0% vs 14.0%, p = 0.018). No significant improvement was observed in rates of other screenings. Although Pap smear completion rates were higher in the intervention arm (41.0% vs 10.4%, p < 0.001), this finding was no longer significant after excluding women's health clinics. Additional on-treatment analysis showed significant increases in mammography (p = 0.019) and influenza vaccination (p = 0.015) for intervention arm patients who opened an eJournal compared to control arm patients, but no differences for any measure among patients who did not open an eJournal.

Conclusions: Providing patients with HM reminders via a PHR may be effective in improving some elements of preventive care.

Figure 1

(a) A patient health maintenance reminder for an overdue Pap smear. (b) Patient-friendly information about the Pap smear.

Figure 2

Flow diagram of a multi-clinic trial comparing a Health Maintenance/Family History personal health record (intervention) to an active control arm receiving access to a Medications/Allergies/Diabetes personal health record. To be eligible for the personal health record study, patients had to have an active Patient Gateway (PG) secure Internet access account with the health network.