Patient portals boost confidence with self-management of hypertension

In Singapore, individuals with hypertension who use online portals appear to feel more self-assured about their ability to manage their condition, as reported in a study.

A cross-sectional survey of multiethnic adult patients with hypertension conducted at a local public primary care clinic showed that patient portal users had higher self-efficacy scores than nonusers. The difference in scores, while small, was significant (mean 63 vs 60 [out of 80]; p=0.011). [J Prim Care Community Health 2024;15:21501319231224253]

Self-efficacy scores were assessed using the Hypertension self-care Profile (HTN-SCP) tool, with a set of 20 questions that open with: “How confident are you that you could do the following?” 

“Self-efficacy, defined as the confidence to adopt the necessary behaviours to reach a desired goal, is a cornerstone of management of patients with hypertension. In between clinical consultation, patients need to adhere to healthy lifestyle behaviours and prescribed therapeutics to attain their target blood pressure control,” study authors from SingHealth Polyclinics, Singapore, said. [Int J Nurs Pract 2021;27:e12920; JAMA  2002;288:2469-2475; Patient Educ Couns 2002;48:177-187; J Community Health. 2012;37:15-24]

“Assessing self-efficacy is vital for healthcare providers to identify patients with poor self-care behaviours and presents opportunities for modification to enhance their adherence to lifestyle changes and therapeutic treatment,” they added.

Patient portal users

Compared with nonusers, patient portal users were more likely to be younger (age <65 years; absolute odds ratio [AOR], 2.634, 95 percent confidence interval [CI], 1.432–4.847; p=0.002), have a monthly income of higher than SGD 5,000 (AOR, 2.324, 95 percent CI, 1.104–4.892; p=0.026), and have completed postsecondary education (AOR, 3.128, 95 percent CI, 1.675–5.839; p<0.001).

Looking at what drives the respondents to visit the portal, checking (93 percent) and scheduling (63.8 percent) medical appointments emerged on top. The portal was also used to make payments (30.0 percent) and view laboratory results (29.8 percent).

A mere 1.3 percent of the respondents used the patient portal to record their home blood pressure measurements (HBPM). Similarly, other functionalities of the portal—health articles, medication lists, and refill requests—were used minimally.

The authors found the infrequent use of the above features, especially HBPM documentation, as “dismal,” given that HBPM allows the patients to monitor their vascular health status and to take appropriate and timely actions to achieve blood pressure control. [Int J Nurs Pract 2021;27:e12920] 

“Physicians often encourage HBPM among the patients due to high prevalence of white coat hypertension, but the latter often forget to bring their paper records during their medical reviews,” the authors pointed out. “The lack of familiarity of such a function in the patient portal is probably the main reason, which may be mitigated if the public and patients are inducted and directed to [the portal’s] functions.” [J Hypertens 2017;35:2388-2394] 

Powerful tool

The patient portal offers a robust toolkit for managing hypertension, according to the authors. Not only does the portal provide convenient features such as appointment scheduling and medication refills, but it also empowers patients by allowing HBPM recording and providing educational resources and dietary and lifestyle guidance—features that help foster high self-efficacy among patients in managing their hypertension.

A total of 310 patients with hypertension (mean age of 63.1 years, 55.5 percent men, 66.8 percent Chinese) completed the survey. Slightly more than half (51.6 percent) of them reported having accessed patient portals, with the average of eight times in the previous 12 months.

Among nonusers, most were unaware of the existence of the portal and had not been introduced to its use. On a positive note, 78 percent of nonusers who had expressed interest in accessing the patient portal in the future had higher levels of self-efficacy than their counterparts who expressed no interest (p<0.001).

“The significant difference in self-efficacy levels between users and nonusers could nudge the multidisciplinary healthcare team, aside from physicians, to induct and promote the use of patient portals among the latter, focusing on those who were older and less [knowledgeable] in digital health,” the authors said.