title: Impact of patient portal secure messages and electronic visits on adult primary care office visits.
abstract: BACKGROUND
  Secure messages and electronic visits ("e-visits") through patient portals provide patients with alternatives to face-to-face appointments, telephone contact, letters, and e-mails. Limited information exists on how portal messaging impacts face-to-face visits in primary care.
  
  
  METHODS
  We conducted a retrospective cohort study of 2,357 primary care patients who used electronic messaging (both secure messages and e-visits) on a patient portal. Face-to-face appointment frequencies (visits/year) of each patient were calculated before and after the first message in a matched-pairs analysis. We analyzed visit frequencies with and without adjustments for a first message surge in visits, and we examined subgroups of high message utilizers and long-term users.
  
  
  RESULTS
  Primary care patients who sent at least one message (secure message or e-visit) had a mean of 2.43 (standard deviation [SD] 2.3) annual face-to-face visits before the first message and 2.47 (SD 2.8) after, a nonsignificant difference (p=0.45). After adjustment for a first message surge in visits, no significant visit frequency differences were observed (mean, 2.35 annual visits per patient both before and after first message; p=0.93). Subgroup analysis also showed no significant change in visit frequency for patients with higher message utilization or for those who had used the messaging feature longer.
  
  
  CONCLUSIONS
  No significant change in face-to-face visit frequency was observed following implementation of portal messaging. Secure messaging and e-visits through a patient portal may not result in a change of adult primary care face-to-face visits.
authors.affiliation: 1 Primary Care Internal Medicine, Mayo Clinic , Rochester, Minnesota.
authors.forename: Frederick
authors.initials: F
authors.lastname: North
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Crane
authors.forename: Rajeev
authors.initials: R
authors.lastname: Chaudhry
authors.forename: Jon O
authors.initials: JO
authors.lastname: Ebbert
authors.forename: Karen
authors.initials: K
authors.lastname: Ytterberg
authors.forename: Sidna M
authors.initials: SM
authors.lastname: Tulledge-Scheitel
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stroebel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016494:Computer Security; D057286:Electronic Health Records; D034742:Electronic Mail; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D033283:Patient Access to Records; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012189:Retrospective Studies; D017216:Telemedicine; D055815:Young Adult