Impact of Patient Portal Secure Messages and Electronic Visits on Adult Primary Care Office Visits

TLDR

Patient portals provide secure messages and electronic visits as alternatives to in‑person appointments, phone calls, letters, and e‑mail. The study aimed to determine whether portal messaging affects face‑to‑face visit frequency among primary‑care patients. The authors compared annual face‑to‑face visit rates before and after a patient’s first portal message, using matched‑pairs analysis and subgroup examinations. After adjusting for an initial surge, portal messaging did not alter face‑to‑face visit frequency, and subgroup analyses confirmed no significant change.

Abstract

Secure messages and electronic visits ("e-visits") through patient portals provide patients with alternatives to face-to-face appointments, telephone contact, letters, and e-mails. Limited information exists on how portal messaging impacts face-to-face visits in primary care.We conducted a retrospective cohort study of 2,357 primary care patients who used electronic messaging (both secure messages and e-visits) on a patient portal. Face-to-face appointment frequencies (visits/year) of each patient were calculated before and after the first message in a matched-pairs analysis. We analyzed visit frequencies with and without adjustments for a first message surge in visits, and we examined subgroups of high message utilizers and long-term users.Primary care patients who sent at least one message (secure message or e-visit) had a mean of 2.43 (standard deviation [SD] 2.3) annual face-to-face visits before the first message and 2.47 (SD 2.8) after, a nonsignificant difference (p=0.45). After adjustment for a first message surge in visits, no significant visit frequency differences were observed (mean, 2.35 annual visits per patient both before and after first message; p=0.93). Subgroup analysis also showed no significant change in visit frequency for patients with higher message utilization or for those who had used the messaging feature longer.No significant change in face-to-face visit frequency was observed following implementation of portal messaging. Secure messaging and e-visits through a patient portal may not result in a change of adult primary care face-to-face visits.