OBJECTIVE Internet-based secure messaging between patients and providers through a patient portal is now common in the practice of modern medicine. There is limited evidence on how messaging is associated with use and clinical quality measures among patients with type 2 diabetes. We examine whether messaging with physicians for medical advice is associated with fewer face-to-face visits and better diabetes management.

RESEARCH DESIGN AND METHODS Patients with diabetes who were enrolled in an online portal of an outpatient health care organization in 2011–2014 were studied (N = 37,762 patient-years). Messages from/to primary care physicians or diabetes-related specialists for medical advice were considered. We estimated the association of messaging with diabetes quality measures, adjusting for patient and provider characteristics and patient-level clustering.

RESULTS Most patients (72%) used messaging, and those who made frequent visits were also more likely to message. Given visit frequency, no (vs. any) messaging was negatively associated with the likelihood of meeting an HbA_1c target of <8% (64 mmol/mol) (odds ratio [OR] 0.83 [95% CI 0.77, 0.90]). Among message users, additional messages (vs. 1) were associated with better outcome (two more messages: OR 1.17 [95% CI 1.06, 1.28]; three more messages: 1.38 [1.25, 1.53]; four more messages: 1.55 [1.43, 1.69]). The relationship was stronger for noninsulin users. Message frequency was also positively associated, but to a smaller extent, with process measures (e.g., eye examination). Physician-initiated messages had effects similar to those for patient-initiated messages.

CONCLUSIONS Patients with diabetes frequently used secure messaging for medical advice in addition to routine visits to care providers. Messaging was positively associated with better diabetes management in a large community outpatient practice.

目的通过患者门户患者和供应商之间基于互联网的安全消息现在是在现代医学的实践中是常见。关于2型糖尿病患者中消息传递与使用和临床质量指标之间的关系的证据有限。我们研究了与医生沟通以寻求医疗建议是否与减少面对面拜访和改善糖尿病管理有关。

研究设计与方法研究了2011-2014年在门诊医疗机构在线门户上注册的糖尿病患者（N = 37,762患者-年）。考虑了来自/发给初级保健医师或糖尿病相关专家的信息，以寻求医疗建议。我们估计了消息传递与糖尿病质量度量之间的关联，并根据患者和提供者的特征以及患者水平的聚类进行了调整。

结果大多数患者（72％）使用消息传递，而那些经常拜访的患者也更可能发出消息。给定访问频率，没有（相对于任何）消息传递与达到<8％（64 mmol / mol）的HbA _1c目标的可能性呈负相关（赔率[OR] 0.83 [95％CI 0.77，0.90]）。在消息用户中，其他消息（相对于1）与更好的结果关联（另外两个消息：OR 1.17 [95％CI 1.06，1.28]；另外三个消息：1.38 [1.25，1.53]；另外四个消息：1.55 [1.43] ，1.69]）。对于非胰岛素使用者而言，这种关系更为牢固。信息频率也与过程措施（例如，眼部检查）呈正相关，但程度较小。医师发起的消息具有与患者发起的消息类似的效果。

结论糖尿病患者除了定期拜访护理人员外，还经常使用安全的消息传递以寻求医疗建议。在大型社区门诊实践中，信息传递与更好的糖尿病管理有着积极的联系。