Qualitative Analysis of Patient Portal Messages From Older Adults With Type 2 Diabetes

Online patient portal messaging may accelerate access to endocrinology care providers for people with diabetes; however, the ways in which older adults use portal messaging as part of their care have not been well characterized. This study aimed to explore the needs, concerns, and health care behaviors expressed in patient-initiated portal messages sent by older adults with type 2 diabetes (T2D) to their endocrinology providers.

We conducted a hybrid deductive and inductive thematic analysis of patient-initiated portal messages from adults aged 65 years or older with T2D receiving diabetes care at the hospital-based outpatient endocrinology clinic. We included all older adults who had one or more visits with a provider in 2023. We analyzed the content from the first message of each thread. Linked electronic health record data were used to characterize the sample.

Among 882 older adults living with T2D receiving outpatient endocrinology care, 427 (48.4%) sent one or more patient portal messages (mean age 71.8 years; 54% women; 72% White). We identified eight themes in portal messages, including 1) barriers to accessing medications, 2) barriers to accessing glucose monitoring supplies, 3) medication questions, 4) unaffordability of care, 5) requests to interpret laboratory or diagnostic results, 6) transmission of glucose monitoring data, 7) nutrition or supplement questions, and 8) general nonurgent medical questions, with corresponding subthemes detailing issues.

The content of patient-initiated portal messages sent by older adults to their endocrinologists included varied topics, with a large portion comprising administrative requests and challenges accessing medications and supplies rather than clinical questions.

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