title: A Patient Portal With Electronic Messaging: Controlled Before-and-After Study.
abstract: BACKGROUND
  Patients' access to their medical records, along with electronic messaging, offers an efficient means of information transition between patients and their caregivers. Easier access to information and interaction with health care professionals may reduce use of other services while increasing patients' activation in the management of their own health. Patient portals may therefore have a favorable impact on the cost-effectiveness of care.
  
  
  OBJECTIVE
  The aim was to assess the benefits and risks of providing electronic messaging services to patients with chronic conditions. Using cost-effectiveness analysis, the outcomes and costs of providing access to an electronic patient portal were evaluated in a real-life treatment process in primary care.
  
  
  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 standard care. Incremental direct heath care costs, health status based on the Short-Form Health Survey, version 2 (SF-36v2), and patient activation based on the short form of the Patient Activation Measure (PAM13) were compared to standard care in a 6-month follow-up. Incremental cost-effectiveness ratios were calculated using a sample of 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. Propensity-score matching was used to assess the sensitivity of the results to the possible attrition bias.
  
  
  RESULTS
  Patient activation improved more in the intervention group but the effect was not statistically significant. The effect on cost of care was ambiguous; costs decreased by an average of €91 in the unadjusted model, but increased by €48 in the adjusted model. Due to the controversial results on cost, the unadjusted analysis showed an 89% probability of cost-effectiveness with no willingness to pay for increased patient activation, whereas in the adjusted sample, the probability of the portal being more cost-effective than care as usual exceeded 50% probability at a willingness to pay €700 per clinically significant increase in patient activation score. There was no marked short-term impact on health status based on the SF-36v2 measure.
  
  
  CONCLUSIONS
  Offering the possibility to substitute health care visits with less costly contacts using self-management tools did not seem to compromise the health status or treatment of chronic care patients. Patient activation increased, and this could be achieved with moderate costs in a short-term experiment. In the long term, increased activation is proposed to lead to better health outcomes and eventually cut down resource use. Future studies should assess the long-term effects of patient portals on patients' health status and cost of care.
authors.affiliation: Department of Industrial Engineering and Management, 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: D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: chronic illness; cost-effectiveness; patient activation; patient portal; self-management