Literature Collection

BACKGROUND: Many adults are overdue for important screenings and vaccines, but providers have limited resources to address these care gaps. Electronic messaging, including patient portal messaging, can be an effective intervention to increase screening and vaccine adherence. However, there is limited research examining variables influencing intervention efficacy beyond demographic variables. OBJECTIVE: This study aims to identify whether patient portal engagement and primary care visits affect the efficacy of patient portal-based screening or vaccine reminders. METHODS: A retrospective analysis of electronic medical record data was used to evaluate the completion of screening mammograms, influenza vaccinations, and fecal immunochemical test (FIT) screenings for approximately 400,000 MyChart patient portal users at a large integrated health system. A logistic regression analysis was performed to calculate odds ratios associated with intervention completion. RESULTS: When adjusted for age, race, and sex, MyChart engagement is associated with increased odds of completing patient portal interventions for mammograms, flu vaccines, and FIT screenings. When adjusted for age, race, and sex, primary care visits are associated with increased odds of completing flu vaccines and FIT screenings but not mammograms following a patient portal intervention. CONCLUSIONS: Overall patient portal engagement is critical to portal-based preventive health interventions. These interventions are most successful when combined with office-based interventions, but there is a potential in some scenarios that digital interventions can be successful without office-based interventions. This research contributes to the existing literature around screening adherence and patient portals' impact on health outcomes.

BACKGROUND: The COVID-19 pandemic catalyzed the adoption of digital technologies in health care. This study assesses a digital-first integrated care model for type 2 diabetes management in Western Sydney, using continuous glucose monitoring (CGM) and virtual Diabetes Case Conferences (DCC) involving the patient, general practitioner (GP), diabetes specialist, and diabetes educator at the same time. OBJECTIVE: This study aims to assess the effectiveness of the innovative diabetes clinics in Western Sydney. METHODS: In 2020, a total of 833 new patients with type 2 diabetes were seen at Western Sydney Diabetes (WSD) clinics. An early cohort of 103 patients was evaluated before and after participation in virtual DCC, incorporating CGM data analysis, digital educational resources, and remote consultations with a diabetes multidisciplinary team. Assessments were conducted at baseline and 3-4 months post DCC. RESULTS: The integration of CGM and virtual consultations significantly improved glycemic control. Hemoglobin A(1c) (HbA(1c)) levels decreased notably from 9.6% to 8.2% (average reduction of 1.4%; 95% CI 1.03-1.82; P<.001). Time in range (TIR) as measured by CGM increased substantially from 46% to 73% (95% CI 20-32; P<.001), and the glucose management indicator (GMI) improved from 7.9% to 7% (average reduction of 0.9%; 95% CI 0.55-1.2; P<.001). Despite no significant change in the total daily insulin dose, the proportion of patients on insulin therapy rose from 27% to 39% (P<.001), indicating more targeted and effective diabetes management. CONCLUSIONS: Our findings demonstrate the effectiveness of a digitally enabled integrated care model in managing type 2 diabetes. The use of CGM technology, complemented by virtual DCCs and digital educational tools, not only facilitated better disease management and patient engagement but also empowered primary care providers with advanced management capabilities. This digital approach addresses traditional barriers in diabetes care, highlighting the potential for scalable, technology-driven solutions in chronic disease management.

Providing human support for users of behavioral health technology can help facilitate the necessary engagement and clinical integration of digital tools in mental health care. A team conducted digital navigator training that taught participants how to promote patrons' digital literacy, evaluate and recommend health apps, and interpret smartphone data. The authors trained 80 participants from 21 organizations, demonstrating this training's feasibility, acceptability, and need. Case studies explore the implementation of this training curriculum. As technology's potential in mental health care expands, training can empower digital navigators to ensure that the use of digital tools is informed, equitable, and clinically relevant.

BACKGROUND: To improve mental health care access, the Veterans Health Administration (VA) implemented Primary Care-Mental Health Integration (PC-MHI) in clinics nationally. Primary care clinical leader satisfaction can inform model implementation and may be facilitated by collaborative care managers and technology supporting cross-specialty collaboration. OBJECTIVE: (1) To determine primary care clinical leaders' overall satisfaction with care from embedded mental health providers for a range of conditions and (2) to examine the association between overall satisfaction and two program features (care managers, technology). DESIGN: Cross-sectional organizational survey in one VA region (Southern California, Arizona, and New Mexico), 2018. PARTICIPANTS: Sixty-nine physicians or other designated clinical leaders in each VA primary care clinic (94% response rate). MAIN MEASURES: We assessed primary care clinical leader satisfaction with embedded mental health care on four groups of conditions: target, non-target mental health, behavioral health, suicide risk management. They additionally responded about the availability of mental health care managers and the sufficiency of information technology (telemental health, e-consult, instant messaging). We examined relationships between satisfaction and the two program features using χ(2) tests and multivariable regressions. KEY RESULTS: Most primary care clinical leaders were "very satisfied" with care for targeted anxiety (71%) and depression (69%), but not for other common conditions (37% alcohol misuse, 19% pain). Care manager availability was significantly associated with "very satisfied" responses for depression (p = .02) and anxiety care by embedded mental health providers (p = .02). Highly rated sufficiency of communication technology (only 19%) was associated with "very satisfied" responses to suicide risk management (p = .002). CONCLUSIONS: Care from embedded mental health providers for depression and anxiety was highly satisfactory, which may guide improvement among less satisfactory conditions (alcohol misuse, pain). Observed associations between overall satisfaction and collaborative care features may inform clinics on how to optimize staffing and technology based on priority conditions.