Secure Messaging with Physicians by Proxies for Patients with Diabetes: Findings from the ECLIPPSE Study

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2019 Aug 21

PMID 31428986

Citations 14

Authors

Wagahta Semere

Scott Crossley

Andrew J Karter

Courtney R Lyles

William Brown 3rd

Mary Reed

Danielle S McNamara

Jennifer Y Liu

Dean Schillinger

Affiliations

Soon will be listed here.

Abstract

Background: Little is known about patients who have caregiver proxies communicate with healthcare providers via portal secure messaging (SM). Since proxy portal use is often informal (e.g., sharing patient accounts), novel methods are needed to estimate the prevalence of proxy-authored SMs.

Objective: (1) Develop an algorithm to identify proxy-authored SMs, (2) apply this algorithm to estimate predicted proxy SM (PPSM) prevalence among patients with diabetes, and (3) explore patient characteristics associated with having PPSMs.

Design: Retrospective cohort study.

Participants: We examined 9856 patients from Diabetes Study of Northern California (DISTANCE) who sent ≥ 1 English-language SM to their primary care physician between July 1, 2006, and Dec. 31, 2015.

Main Measures: Using computational linguistics, we developed ProxyID, an algorithm that identifies phrases frequently found in registered proxy SMs. ProxyID was validated against blinded expert categorization of proxy status among an SM sample, then applied to identify PPSM prevalence across patients. We examined patients' sociodemographic and clinical characteristics according to PPSM penetrance, "none" (0%), "low" (≥ 0-50%), and "high" (≥ 50-100%).

Key Results: Only 2.3% of patients had ≥ 1 registered proxy-authored SM. ProxyID demonstrated moderate agreement with expert classification (Κ = 0.58); 45.7% of patients had PPSMs (40.2% low and 5.5% high). Patients with high percent PPSMs were older than those with low percent and no PPSMs (66.5 vs 57.4 vs 56.2 years, p < 0.001) had higher rates of limited English proficiency (16.1% vs 3.2% vs 3.5%, p < 0.05), lower self-reported health literacy (3.83 vs 4.43 vs 4.44, p < 0.001), and more comorbidities (Charlson index 3.78 vs 2.35 vs 2.18, p < 0.001).

Conclusions: Among patients with diabetes, informal proxy SM use is more common than registered use and prevalent among socially and medically vulnerable patients. Future research should explore whether proxy portal use improves patient and/or caregiver outcomes and consider policies that integrate caregivers in portal communication.

Citing Articles

A Multisite Demonstration of Shared Access to Older Adults' Patient Portals.

Gleason K, DesRoches C, Wu M, Peereboom D, Dukhanin V, Farrell T JAMA Netw Open. 2025; 8(2):e2461803.

PMID: 39998827 PMC: 11862967. DOI: 10.1001/jamanetworkopen.2024.61803.

Care Partner Engagement in Secure Messaging Between Patients With Diabetes and Their Clinicians: Cohort Study.

Semere W, Karter A, Lyles C, Reed M, Karliner L, Kaplan C JMIR Diabetes. 2024; 9:e49491.

PMID: 38335020 PMC: 10891488. DOI: 10.2196/49491.

The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating.

Reynolds T, Cobb J, Steitz B, Ancker J, Rosenbloom S Appl Clin Inform. 2023; 14(4):654-669.

PMID: 37611795 PMC: 10446914. DOI: 10.1055/s-0043-1770901.

Improving Cancer Care Communication: Identifying Sociodemographic Differences in Patient Portal Secure Messages Not Authored by the Patient.

Armstrong M, Benda N, Seier K, Rogers C, Ancker J, Stetson P Appl Clin Inform. 2023; 14(2):296-299.

PMID: 36657471 PMC: 10115514. DOI: 10.1055/a-2015-8679.

Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations: A Scoping Review.

Gleason K, Peereboom D, Wec A, Wolff J JAMA Netw Open. 2022; 5(12):e2248696.

PMID: 36576738 PMC: 9857556. DOI: 10.1001/jamanetworkopen.2022.48696.

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