Personal health records and hypertension control: A randomized trial

School of Medicine, Department of Family Medicine, Georgia Health Sciences University, Augusta, Georgia, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 01/2012; 19(4):626-34. DOI: 10.1136/amiajnl-2011-000349
Source: PubMed


To examine the impact of a personal health record (PHR) in patients with hypertension measured by changes in biological outcomes, patient empowerment, patient perception of quality of care, and use of medical services.
A cluster-randomized effectiveness trial with PHR and no PHR groups was conducted in two ambulatory clinics. 453 of 1686 (26.4%) patients approached were included in the analyses. A PHR tethered to the patient's electronic medical record (EMR) was the primary intervention and included security measures, patient control of access, limited transmission of EMR data, blood pressure (BP) tracking, and appointment assistance. BP was the main outcome measure. Patient empowerment was assessed using the Patient Activation Measure and Patient Empowerment Scale. Quality of care was assessed using the Clinician and Group Assessment Score (CAHPS) and the Patient Assessment of Chronic Illness Care. Frequency of use of medical services was self-reported.
No impact of the PHR was observed on BP, patient activation, patient perceived quality, or medical utilization in the intention-to-treat analysis. Sub-analysis of intervention patients self-identified as active PHR users (25.7% of those with available information) showed a 5.25-point reduction in diastolic BP. Younger age, self-reported computer skills, and more positive provider communication ratings were associated with frequency of PHR use.
Few patients provided with a PHR actually used the PHR with any frequency. Thus simply providing a PHR may have limited impact on patient BP, empowerment, satisfaction with care, or use of health services without additional education or clinical intervention designed to increase PHR use. Identifier: NCT01317537.

Download full-text


Available from: Kristina W Kintziger, Sep 03, 2015
  • Source
    • "Given the limited number of studies that met the inclusion criteria for this review, we conducted a qualitative secondary analysis of 11 additional trials [14,42-51] that met all of the inclusion criteria with one exception: the measure of patient engagement lacked one of the three key a priori components (data not shown). Specifically, seven studies [14,43,46-50] (63.6%) did not measure knowledge, one study did not measure confidence [42] (9.1%), and three studies [44,45,51] (27.3%) did not measure any health behaviors; six [43,44,47,48,50,51] of these studies (54.5%) were of high quality. We described these studies according to the same data fields as described in the primary analyses above. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The role of patient engagement as an important risk factor for healthcare outcomes has not been well established. The objective of this article was to systematically review the relationship between patient engagement and health outcomes in chronic disease to determine whether patient engagement should be quantified as an important risk factor in health risk appraisals to enhance the practice of personalized medicine. A systematic review of prospective clinical trials conducted between January 1993 and December 2012 was performed. Articles were identified through a medical librarian-conducted multi-term search of Medline, Embase, and Cochrane databases. Additional studies were obtained from the references of meta-analyses and systematic reviews on hypertension, diabetes, and chronic care. Search terms included variations of the following: self-care, self-management, self-monitoring, (shared) decision-making, patient education, patient motivation, patient engagement, chronic disease, chronically ill, and randomized controlled trial (RCT). Studies were included only if they: (1) compared patient engagement interventions to an appropriate control among adults with chronic disease aged 18 years and older; (2) had minimum 3 months between pre- and post-intervention measurements; and (3) defined patient engagement as: (a) understanding the importance of taking an active role in one's health and health care; (b) having the knowledge, skills, and confidence to manage health; and (c) using knowledge, skills and confidence to perform health-promoting behaviors. Three authors and two research assistants independently extracted data using predefined fields including quality metrics. We reviewed 543 abstracts to identify 10 trials that met full inclusion criteria, four of which had "high" methodological quality (Jadad score >= 3). Diverse measurement of patient engagement prevented robust statistical analyses, so data were qualitatively described. Nine studies documented improvements in patient engagement. Five studies reported reduction in clinical markers of disease (e.g., HbA1C). All studies reported improvements in self-reported health status. This review suggests patient engagement should be quantified as part of a comprehensive health risk appraisal given its apparent value in helping individuals to effectively self-manage chronic disease. Patient engagement measures should include assessment of the knowledge, confidence and skills to prevent and manage chronic disease, plus the behaviors to do so.
    Full-text · Article · Feb 2014 · Genome Medicine
  • Source
    • "Controlling BP is felt to be one of the most cost-effective interventions for improving the health of persons with diabetes and hypertension , yet control of hypertension in persons with diabetes remains inadequate [5] [6] [7] [8]. While others have approached control of hypertension using home self-monitoring and manual reporting, telephonic uploading, custom home equipment including a computer and video link along with a dedicated case manager [9], custom web portals [10], or clinical pharmacists [11] [12], the CONDUIT intervention uses existing nurses (RNs) and medical assistants (MAs), staff already employed in virtually all practice settings, a low-cost BP monitor, and a free online application. The study will evaluate, via a randomized controlled trial (RCT) of 400 patients, whether this low-cost CHI intervention improves clinical outcomes for this patient population. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The CONDUIT-HID intervention integrates patients’ electronic blood pressure measurements directly into the clinical EHR using Microsoft HealthVault as an intermediary data store. The goal of this paper is to describe generalizable categories of patient and technical challenges encountered in the development and implementation of this inexpensive, commercial off-the-shelf consumer health informatics intervention, examples of challenges within each category, and how the example challenges were resolved prior to conducting an RCT of the intervention.
    Full-text · Article · Jun 2013 · International Journal of Medical Informatics
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper explores the range of self-tracking devices and social media platforms used by the self-tracking community, and examines the implications of widespread adoption of these tools for scientific progress in health informatics. A literature review was performed to investigate the use of social media and self-tracking technologies in the health sector. An environmental scan identified a range of products and services which were used to exemplify three levels of self-tracking: self-experimentation, social sharing of data and patient controlled electronic health records. There appears to be an increase in the use of self-tracking tools, particularly in the health and fitness sector, but also used in the management of chronic diseases. Evidence of efficacy and effectiveness is limited to date, primarily due to the health and fitness focus of current solutions as opposed to their use in disease management. Several key technologies are converging to produce a trend of increased personal health surveillance and monitoring, social connectedness and sharing, and integration of regional and national health information systems. These trends are enabling new applications of scientific techniques, from personal experimentation to e-epidemiology, as data gathered by individuals are aggregated and shared across increasingly connected healthcare networks. These trends also raise significant new ethical and scientific issues that will need to be addressed, both by health informatics researchers and the communities of self-trackers themselves.
    No preview · Article · Aug 2012 · Yearbook of medical informatics
Show more