- Clinicians can use EHR data to deliver wellness program messages to patients at-risk for certain chronic conditions, such as diabetes. However, program developers must take care in how they deliver these messages to be sensitive to patient preferences, according to research published in the American Journal of Managed Care.
Wellness programs have proven effective in reducing the occurrence of type 2 diabetes in adults, but are difficult to scale and leave many patient populations underrepresented.
Currently, minority women who have a history of gestational diabetes are underrepresented in wellness programs.
In general, minority women are not included in wellness program outreach, the researchers explained. Additionally, patients with gestational diabetes are often unaware of their future diabetes risks and fragmented care leaves these patients’ prior diabetes diagnoses largely unknown.
EHR data can help better target wellness efforts to patients who truly need it, such as minority women with a history of gestational diabetes. EHR data can also lead to risk stratification, helping providers to target their efforts to the appropriate patient populations.
Wellness program developers can better tailor messages to drive efficacy through a careful understanding of how patients perceive these messages.
The research team from Kaiser Permanente Northern California enrolled 36 women who previously had gestational diabetes in a messaging intervention. Eighty percent of those patients were a part of an ethnic minority.
The researchers then collected qualitative data about the responses to the targeted risk messages. The qualitative research revealed a slew of contradicting patient perspectives.
“Although EHR-driven tailored messages have potential as an efficient and cost-effective outreach strategy, divergent patient reactions highlight key challenges,” the researchers reported.
For example, patients disagreed about whether these messages spurred privacy concerns. Patients felt more confident in message privacy when their personal provider or the provider organization sent the message.
However, other patients had concerns about multiple doctors having access to their EHR data. Despite those concerns, the patients acknowledged broad data access for supporting care coordination.
Patients also disagreed over the authenticity of the messages. Personalized messages that included several patient details were perceived as genuine and authentic for some patients. These patients said personalized messages gave the impression that someone cared about them enough to parse through the medical information to make a diagnostic prediction.
Other patients said that overly-personalized messages came off as disingenuous and “spammy.” Patients said these messages appeared computer-generated and did not inspire confidence.
Additionally, patients had contrasting views about disclosing risk-related information. Some patients reported feeling offended or insulted by this information, reporting that messages were “telling me what I already know.”
These patients also found mention of risk factors directly tied to one’s ethnicity as culturally insensitive and as a form of racial profiling, the researchers said.
Other patients viewed messages that contained risk information as friendly reminders and particularly valued messages that acknowledge prior efforts for improving one’s health.
“Participants described preferences for strong, clear, and hopeful messages that clearly communicated their risk for diabetes and actions needed to prevent it, thus empowering women with the information and resources needed to ‘get it fixed,’” the researchers reported.
Although patients couldn’t agree on much, they did agree on one characteristic: messages signed by one’s provider were far more effective than those signed by another clinician.
“Participants perceived their physician as trustworthy and concerned about their health and noted that they were more likely to read a tailored message that came directly from that individual,” the researchers found.
Although messages were better received from one’s personal provider, participants stated that receiving a message from a member of the organization would also be helpful. Patients largely recognized the importance of care coordination and understood that members of an organization are working as a team to improve patient health.
These findings indicate a careful, although difficult, path forward for wellness program developers.
Wellness program developers and those who design risk-based messages should always reassure patients of data security. The messages should also be signed by a patient’s personal clinician or a relevant member of the healthcare organization.
Healthcare professionals should work to include risk-based information in the wellness messages, but take measures to articulate this information sensitively and in a positive manner. Making the messages less threatening will help improve patient satisfaction while communicating essential information to patients.
“Results among women at high risk for diabetes suggested that patients acknowledge both the advantages and pitfalls of tailored approaches to outreach,” the researchers concluded.
“Optimal outreach may require communication from personal physicians, mitigating privacy and authenticity concerns, and applying theory-based approaches to counteract the threatening nature of personalized risk communication.”