Mobile apps, patient portals, and EHRs are promising tools to enhance recommended behaviors for DM. This study reports whether these technologies could effectively deliver patient-centered DSME/S for older people with DM.
We analyzed 179 of 1050 DM apps according to AADE7 self-care principles. Most DM apps included features of Monitoring (73%). Few apps supported Healthy Coping (9%), an essential principle for older adults with DM challenged with comorbid conditions. In addition, two focus groups (n=10, mean age=67) revealed a low usability score: 48/100. Participants had trouble using the apps due to poor navigation, visual and physical limitations.
We also analyzed 200 visit notes randomly selected from 2634 notes of adults with DM from an EHR that provides access to clinic notes via a patient portal. Notes were written at Flesch Kincaid level 9.6. Using AADE7 principles, we conducted a thematic analysis to determine patterns of DSME/S information. Out of 3735 codes, Monitoring (48%) was addressed most frequently, possibly due to insurance requirements. Healthy Coping (2%) was addressed least frequently, possibly due to time constraints. Generalized linear mixed models revealed no significant associations between DSME/S delivered and patient demographic/DM control measures. Many patients shared data about glycemic control (88%) and had active patient accounts (50%) allowing access to clinical data.
Our study shows that features and content of DM apps are not ideal for older adults. We found that patient notes in EHR were above NIH recommended readability levels (6th grade) and many older adults may not understand key points. We did find that older people have access to patient portals, and share information with providers. Patient portals are increasingly available through EHR. User-centered design process should be employed for patient-centered DSME/S to facilitate usability, readability, and information sharing through patient portals for older people with DM.
M. Kim: None. U.Z. Khan: None. S.A. Boren: None. Q. Ye: None. E.J. Simoes: None.
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092950)