title: The effect of a patient portal with electronic messaging on patient activation among chronically ill patients: controlled before-and-after study.
abstract: BACKGROUND
  It has been suggested that providing patients with access to their medical records and secure messaging with health care professionals improves health outcomes in chronic care by encouraging and activating patients to manage their own condition.
  
  
  OBJECTIVE
  The aim was to evaluate the effect of access to a patient portal on patient activation among chronically ill patients. Further, the relationship between temporal proximity of a severe diagnosis and patient activation were assessed.
  
  
  METHODS
  A total of 876 chronically ill patients from public primary care were allocated to either an intervention group receiving immediate access to a patient portal that included their medical records, care plan, and secure messaging with a care team, or to a control group receiving usual care. Patient Activation Measure (PAM) at baseline and at 6-month follow-up was obtained from 80 patients in the intervention group and 57 patients in the control group; thus, a total of 137 patients were included in the final analysis.
  
  
  RESULTS
  No significant effect of access to patient portal on patient activation was detected in this study (F1,133=1.87, P=.17, η(2)=0.01). Patients starting at a lower level of activation demonstrated greater positive change in activation compared to patients starting at higher levels of activation in both the intervention and control groups. Further, patients diagnosed with a severe diagnosis during the intervention showed greater positive change in patient activation compared to patients whose last severe diagnosis was made more than 2 years ago. The results also suggest that the intervention had greatest effect on patients starting at the highest level of patient activation (difference in change of patient activation=4.82, P=.13), and among patients diagnosed within a year of the intervention (difference in change of patient activation=7.65, P=.12).
  
  
  CONCLUSIONS
  Time since last severe diagnosis and patient activation at baseline may affect changes in patient activation, suggesting that these should be considered in evaluation of activating chronic care interventions and in the specification of possible target groups for these interventions. This may be relevant in designing services for a heterogeneous group of patients with a distinct medical history and level of activation.
authors.affiliation: Aalto University, Espoo, Finland. iiris.riippa@aalto.fi.
authors.forename: Iiris
authors.identifier: http://orcid.org/0000-0001-9024-4153
authors.initials: I
authors.lastname: Riippa
authors.forename: Miika
authors.identifier: http://orcid.org/0000-0002-7660-2484
authors.initials: M
authors.lastname: Linna
authors.forename: Ilona
authors.identifier: http://orcid.org/0000-0002-0979-2919
authors.initials: I
authors.lastname: Rönkkö
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002908:Chronic Disease / Q000628:therapy*; D003142:Communication; D003920:Diabetes Mellitus / Q000628:therapy; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000628:therapy; D006973:Hypertension / Q000628:therapy; D008297:Male; D008875:Middle Aged; D033283:Patient Access to Records; D010346:Patient Care Management; D010358:Patient Participation; D011369:Professional-Patient Relations; D012648:Self Care; D011795:Surveys and Questionnaires
keywords: chronic illness; diagnosis; patient activation; self-management