The Use of Web-Based Health Education among Safety-Net Ambulatory Care Clinic Adult Diabetic Patients

Background: A large public safety-net hospital system implemented a web-based video education program to improve chronic disease management outcomes. Using animation and a calm engaging voice, the program explains complex medical information and directs patients on making healthy lifestyle choices and decisions regarding their care. Patients receive notification that web-based education has been ordered for them either verbally by a care team member, on an after-visit summary, or through the organization’s patient portal. The video is then accessed via smartphone, tablet, laptop, or desktop computer. If the video is not accessed by the patient or caregiver within 6-8 weeks, the order expires and is no longer available. Initial evaluations of the initiative found that patients who completed the web-based education reported the program: “helped them manage their health”, “answered questions they would have called their doctor to discuss,” and “motivated them to change their lifestyles.” However, the video programs were viewed by a very small number of patients and little was known about the profile or demographic make-up of the patients who were most likely to complete the videos. Without this information, determining how to reach the most complex patients is a difficult task.

Purpose: To identify factors associated with the use of an online, web-based health education program among diabetic patients at five ambulatory care clinics of a large public safety-net hospital system.

Methodology: A retrospective chart review of the electronic health record was conducted. Diabetic patients who had active orders for the web-based programs were identified on patient registries.

Analysis: Mean, frequencies, and percentages were calculated to the describe sample. Chi square, t-tests, ANOVA, and multiple regression were used to answer the research questions.

Results: N=300. Only 5.3% (16) patients completed the diabetes type 2 education video, and 9.3% (28) completed the diabetic eye exam education video. Patients who completed a web-based video more likely to be younger, caucasian, living outside of inner-city core, and users of the organization’s patient portal; they were also more likely to complete their annual diabetic eye exam. No association between the completion a web-based video and gender, number of clinic visits, number or type of co-morbid conditions, or medical insurance. Use of patient portal was the most predictive variable for completing at least one web-based video, completion of diabetic eye exams, and improving hemoglobin A1c.
Conclusion: The use of eHealth technology has great potential to empower patients to take a more active role in managing their health conditions and ultimately achieving improved health outcomes as seen with the results related to diabetes management in this study. To maximize the positive impact of eHealth and web-based disease management support tools, health care organizations must consider barriers to the use of these tools. Future research will focus on strategies to address issues of access to digital devices, eHealth literacy deficits, and varying comfort levels with the use of the evolving technology.

Learning outcome: Describe factors influencing use of technology for patient education at a large public safety-net hospital system.