Secure e-mail in Diabetes Care. A pilot study

Background: Patient-provider e-mail communication has the potential to fill unmet needs of patients with chronic conditions. E-mail use in diabetes care has been associated with improved patient outcomes. This pilot RCT tested the effects of access to a practice-integrated secure e-mail service (EMS), compared to usual care on problem areas such as anxiety, depression, quality of life (QoL) satisfaction with treatment and changes in glycemic control (HbA1C) in patients with Diabetes type I who were followed for 6 months. Methods: 78 patients at a university hospital were randomized into the EMS group (n=39), whose members could send messages to, and receive answers from nurses, physicians and nutritionists at their hospital or the usual care group (n=39). Linear mixed models for repeated measures were fitted to compare effects on patient outcomes over time, using an intention to treat approach. In addition, interviews were conducted with four patients in the EMS group. Results: There was a large range in time since diagnosis among the respondents (0-58 years) and the usual care group members were significant older than the EMS group (49 years/39 years; p.041). In the EMS group 23% (n=9) sent e-messages (median 1, range 1-13). There were no significant differences over time between the EMS group and the control group in terms of problem areas in diabetes (PAID), anxiety (Hospital Anxiety and Depression Scale (HADS)), depression (HADS), QoL (WHO-5), satisfaction with treatment (DTSQ) or HbA1c. Interviews revealed that the patients were satisfied with having the opportunity to send messages to their health care providers. Conclusion: No differences were revealed between the group with access to e-mail compared to the control group on self reported outcomes or changes in HbA1c. Lessons learned are to recruit a more homogenous group in terms of time since diagnosis to be able to detect differences. E-mail access to health care providers might be more beneficial to newly diagnosed people with diabetes type I and thus address unmet information needs in this patient group.