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Limited Adoption Limits Patient Portal Decision Aid Efficacy

While patient portal decision aids can be effective, limited patient adoption rates are keeping them from full potential.

Patient portal decision aids have low adoption despite efficacy.

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- Patient portals and other health IT can effectively host decision aids for patients, if only they and their clinicians adopt the tools, according to a study published in the Annals of Family Medicine.

Having adequate patient decision-making tools is integral as patient-centered healthcare continues to take hold of the industry. Patients are in the driver’s seat for more of their own healthcare decisions, with clinicians helping to guide the process. However, clinicians often face barriers to effectively carrying out those duties.

“The competing demands and time constraints associated with office visits limit the help clinicians can realistically provide,” the researchers explained.

“More importantly, both difficult and even routine choices might entail a ‘decision journey’ — that is, the support required may extend over time, a period during which patients may contemplate options, gather additional information, confer with family and friends, consider personal preferences, and address worries or concerns,” the team continued.

Technology can help enhance patient decision-making by anticipating patient needs, where the patient is in the decision-making process, personalizing patient education, facilitating patient data access and exchange, and supporting follow-up care communications.

READ MORE: How Patient Portals Improve Patient Engagement

Attaching a decision aid to a technology such as a patient portal has the potential to follow the patient “decision journey” both inside and outside the clinician office.

A comparative analysis of health IT decision aids showed that these tools are effective in supporting patients and their care. The research team introduced the decision aid to 12 practices, offering its use to 55,453 patients who might face a decision about getting a cancer screening.

Overall, one-fifth of portal users faced a cancer screening, which shows a high need for a digital decision aid, the researchers argued. Among those patients, 20 percent started using the tool and about 8 percent completed the tool’s module.

Forty-seven percent of those who fully completed the module shared their responses with their clinicians, and many patients thought the module helped enhance their care. Forty-one percent of patients thought the tool made their appointments more productive, 48 percent thought it helped engage them in the cancer screening decision, 48 percent thought it improved their health literacy, and 37 percent thought the tool improved patient-provider communication.

Although the tool proved effective for many patients, the researchers still reported grim findings, with very few patients actually utilizing the decision aid.

READ MORE: How Patient Portal Assessments Can Improve Patient Engagement

“We found that practices had large decision burdens—with 1 in 5 patients facing a decision—yet only 20.6 percent of patients facing a decision started and 7.9 percent completed our decision module,” the team noted.

A handful of use trends did offer insights into how to improve decision aid uptake, the researchers reported.

When clinicians linked the module with a specific appointment or a specific screening decision, patients were more likely to use it. Pointing out a use for the tool inspired patients to adopt the decision aid more than simply letting patients know the tool was there. The need to make a healthcare decision likely prompted increased uptake, the researchers observed.

The decision aid likely had low uptake due to technological barriers and limited patient and clinician buy-in, the researchers said. Overcoming those uptake barriers will require further research.

“Implementing this model of using technology for decision making is likely to encounter technologic challenges, and engaging patients online and integrating the process with practice workflow may not be easy,” the research team said.

READ MORE: Using Shared Decision-Making to Spark Quality Patient Care

“If, however, future research confirms the benefits of this approach—more informed patients, better decisions, and wiser use of encounter time—the return on investment could offset the implementation costs and improve care,” the researchers concluded.

Adding more modules to the patient portal is an emerging strategy for healthcare professionals looking to deliver more personalized healthcare. In this case, adding decision aid functions to the portal effectively helped patients make their own individual care decisions, despite low uptake.

Other recent research from the Columbia University School of Nursing has shown that adding personalized educational tools to the patient portal can help drive patient self-management.

Lead researcher Adriana Arcia developed a tool that linked to the patient portal and sent push notifications to pregnant patients. These notifications contained links to educational materials based upon a specific patient’s needs.

This tool might be effective for other patients, not just those who are pregnant, Arcia concluded.

“It is possible that there are other situations in which patients would appreciate receiving pushed content based upon one or more data elements in the EHR,” Arcia wrote. “We envision that this popular feature could be extended to other data elements within the EHR to support clients’ learning needs for a variety of health conditions.”

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