Abstract
BackgroundPatient portals may improve communication between families of children with asthma and their primary care providers and improve outcomes. However, the feasibility of using portals to collect patient-reported outcomes from families and the barriers and facilitators of portal implementation across diverse pediatric primary care settings have not been established.ObjectiveWe evaluated the feasibility of using a patient portal for pediatric asthma in primary care, its impact on management, and barriers and facilitators of implementation success.MethodsWe conducted a mixed-methods implementation study in 20 practices (11 states). Using the portal, parents of children with asthma aged 6-12 years completed monthly surveys to communicate treatment concerns, treatment goals, symptom control, medication use, and side effects. We used logistic regression to evaluate the association of portal use with child characteristics and changes to asthma management. Ten clinician focus groups and 22 semistructured parent interviews explored barriers and facilitators of use in the context of an evidence-based implementation framework.ResultsWe invited 9133 families to enroll and 237 (2.59%) used the portal (range by practice, 0.6%-13.6%). Children of parents or guardians who used the portal were significantly more likely than nonusers to be aged 6-9 years (vs 10-12, P=.02), have mild or moderate/severe persistent asthma (P=.009 and P=.04), have a prescription of a controller medication (P<.001), and have private insurance (P=.002). Portal users with uncontrolled asthma had significantly more medication changes and primary care asthma visits after using the portal relative to the year earlier (increases of 14% and 16%, respectively). Qualitative results revealed the importance of practice organization (coordinated workflows) as well as family (asthma severity) and innovation (facilitated communication and ease of use) characteristics for implementation success.ConclusionsAlthough use was associated with higher treatment engagement, our results suggest that achieving widespread portal adoption is unlikely in the short term. Implementation efforts should include workflow redesign and prioritize enrollment of symptomatic children.ClinicalTrialClinicaltrials.gov NCT01966068; https://clinicaltrials.gov/ct2/show/NCT01966068 (Archived by WebCite at http://www.webcitation.org/6i9iSQkm3)
Highlights
Patient portals, Web-based health care applications that enable patients to interact and communicate with their health care providers from outside the office [1], offer a resource to improve communication between patients and clinicians between visits
Conclusions: use was associated with higher treatment engagement, our results suggest that achieving widespread portal adoption is unlikely in the short term
This study evaluated the determinants of implementation success for a portal in pediatric primary care to facilitate communication between families and clinicians regarding treatment concerns and goals, asthma symptoms, medication use, and side effects
Summary
Web-based health care applications that enable patients to interact and communicate with their health care providers from outside the office [1], offer a resource to improve communication between patients and clinicians between visits. Patient portal use has increased recently [2]; adoption has not been rapid [3], and overall rates of sustained use remain low [4]. Recent research suggests that to effectively engage patients as portal users, several barriers may need to be overcome. Studies have found that patients who are white and have more health problems are more likely to use portals than others [4,6-8]. Portals have not been as widely used in pediatrics as in the adult setting. Patient portals may improve communication between families of children with asthma and their primary care providers and improve outcomes. The feasibility of using portals to collect patient-reported outcomes from families and the barriers and facilitators of portal implementation across diverse pediatric primary care settings have not been established
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
