Is Provider Secure Messaging Associated With Patient Messaging Behavior? Evidence From the US Army

BACKGROUND: Secure messaging with health care providers offers the promise of improved patient-provider relationships, potentially facilitating outcome improvements. But, will patients use messaging technology in the manner envisioned by policy-makers if their providers do not actively use it? OBJECTIVE: We hypothesized that the level and type of secure messaging usage by providers might be associated with messaging initiation by their patients. METHODS: The study employed a dataset of health care and secure messaging records of more than 81,000 US Army soldiers and nearly 3000 clinicians with access to a patient portal system. We used a negative binomial regression model on over 25 million observations to determine the adjusted association between provider-initiated and provider-response messaging and subsequent messaging by their patients in this population over a 4-year period. RESULTS: Prior provider-initiated and response messaging levels were associated with new patient messaging when controlling for the patient’s health care utilization and diagnoses, with the strongest association for high provider-response messaging level. Patients whose providers were highly responsive to the messages of other patients initiated 334% more secure messages (P<.001) than patients with providers who did not personally respond to other patients’ messages. CONCLUSIONS: Our results indicate that provider messaging usage levels and types thereof predict their patients’ subsequent communication behavior. The findings suggest the need for more study into the factors associated with provider messaging to fully understand the mechanisms of this relationship.