1. The Next Step: Achieving Health Behavior Change Through Technology

2. Name the movie & the meme… If you build it, will they come?

3. Research Questions RWJ: RFP to evaluate patient portals (MyGeisinger) For patients with chronic conditions (DM, CVD, CHF), do e-health interventions influence: –Measures of: patient activation patient self-management treatment adherence patient satisfaction with care disease specific knowledge –Process measures of appropriate CVD/DM/CHF care HbA1c, LDL tests Prescribed meds –Clinical markers of cardiovascular/DM morbidity & risk SBP, HbA1c, LDL

4. Intervention Web-based health behavior change program – Care For Your Health (HealthMedia, Inc) Objective: –create “expert patients” with the confidence, skills, and knowledge to self-manage Method: –Patient completes initial assessment online (~80 items) –Customized “plan” that helps patients focus on: acceptance of condition communication with providers lifestyle choices goal setting medication/treatment adherence planning skills –Visit the site initially to complete assessment, return to review plan and use additional tools

6. Study Design

7. Recruitment Model First phase: –Initial letter from director of Geisinger’s ambulatory clinics Follow-up letters (2) Follow-up emails (2) Second phase: –Letter from PCP Follow-up PCP letter (2) Follow-up PCP email (2) Letter content: –General info about the study and intervention –Instructions on how to log into MyGeisinger & click the link to Care For Your Health

8. Results: Overall Primary Endpoints (6 and 12 month f/u): –No effect on process measures No difference in rates of appropriate testing (e.g. A1c, foot exams) or appropriate use of medications (e.g. ACE-I for CHF) –No effect on clinical measures No difference in SBP, DBP, LDL, Total Chol, A1c –No effect on patient-reported outcomes Patient activation, adherence, satisfaction

9. What happened? Enrollment problems: –Only 247 (~) 17%patients enrolled in CFYH Were patients unaware of the intervention? –Interim survey Are patients just not interested in e-health? –Analysis of MyGeisinger vs. HMI use

10. Results: Interim Phone Survey Surveyed 30 random non-enrollees to identify reasons for non-enrollment (~11%) Findings: –90% use the Internet at least once per week –100% recalled receiving the invitation letter 67% did not recognize the physician signing the letter 42% said recognizing physician mattered –47% - wanted more information –67% - technical problems Conclusion: –they know about the intervention

11. Results: MyGeisinger Use Analyzed 12 months of MyGeisinger use –Analyzed log files Results: –86% used the Internet for at least 3 sessions during the 12-month period –Most popular functions: Lab results, Messaging, Proxy access –Clear presence of user “clusters” Portal use for specific purposes: Proxy users, lab trackers, appointment “preppers”, etc. Conclusions: –Patients like, and actively use, electronic tools for health- related purposes

12. Conclusions Study participants WERE aware of and using “e-health” “E-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies.” – Eysenbach, J Med Internet Res 2001 There is a fundamental difference in the process of engaging patient in accessing information (i.e. EHR, lab data) vs. health behavior change –Immediate gratification vs. long-term health

13. Conclusions (cont’d) “Simple” solutions: –Need to make it simple for patients –Patients need better information The primary care physician is important Complex solutions –Not all e-health is created equal… Accessing data vs. behavior change –Health behavior change is difficult on the web, just as it is in a paper-based world –If you build it, “they” won’t necessarily come –Who are “they” Need to understand who, why, how to develop better approaches to engaging patients

14. Questions?

15. Future Research Understanding patient engagement and activation –Eysenbach (2001) – the law of “attrition” Important, but how do we engage them (non-early adopters) in the first place? Current studies –“Risk-informed engagement” eCVD-II eAspirin

16. Pictures

17. Custom Animations