Impact of a Wellness Portal on the delivery of patient-centered preventive care

Abstract

Background: The objective of this study was to determine the impact of the Wellness Portal--a novel, web-based patient portal that focuses on wellness, prevention, and longitudinal health--on the delivery of patient-centered preventive care by examining the behavior and experiences of both patients and primary care clinicians and the degree to which recommended services were individualized and provided.

Methods: We conducted a 3-year, systematic portal development and testing study, which included a 6-month feasibility and acceptability pilot in 2 primary care practices followed by a 12-month cluster randomized controlled trial in 8 clinician practices (4 in each study group). Descriptive and bivariate analyses were conducted to compare service delivery between intervention and control arms.

Results: Ninety percent of patients in the pilot study found the portal easy to use, 83% found it to be a valuable resource, and 80% said that it facilitated their participation in their own care. The cluster randomized controlled trial included 422 adults 40 to 75 years of age and the parents of 116 children 2 to 5 years of age. Seventy three percent of patients used the portal during the study. Both patient activation (measured via the 13-item Patient Activation Measure) and participants' perception of patient-centeredness of care (measured via the Consumer Assessment of Healthcare Providers and Systems instrument) increased significantly in the portal group compared with control (P = .0014 and P = .037, respectively). A greater proportion of portal users received all recommended preventive services (84.4% intervention vs 67.6% control; P < .0001); took low-dose aspirin, if indicated (78.6% intervention vs 52.3% control; P < .0001); and received Pneumovax because of chronic health conditions (82.5% vs 53.9%; P < .0001) and age (86.3% vs 44.6%; P < .0001), despite having fewer visits over the study period compared with those in the control group (average of 2.9 vs 4.3 visits; P < .0001). Children in the intervention group received 95.5% of all recommended immunizations compared with 87.2% in the control group (P = .044).

Conclusions: A comprehensive patient portal integrated into the regular process of primary care can increase the patient-centeredness of care, improve patient activation, enhance the delivery of both age- and risk factor-appropriate preventive services, and promote the utilization of web-based personal health records.