Patient Portal Use in the Management of Asthma and COPD: A Systematic Review of Quality-of-Care Outcomes. (Preprint)

BACKGROUND Patient portals offer access to patient health information and are used to support self-management and facilitate care-coordination in people with chronic diseases. Previous studies have reported some benefits from patient portal on chronic respiratory disease care, but an up-to-date evidence review is required. OBJECTIVE To systematically synthesise evidence on the impacts of patient portals on adult asthma and Chronic Obstructive Pulmonary Disease (COPD) outcomes across six quality-of-care domains (effectiveness, patient-centeredness, equity, efficiency, safety and timeliness). METHODS We searched five databases (Medline/Pubmed, Embase, PsycINFO, CINAHL, and Google Scholar) for quantitative evaluations published up to January 2025 (CRD42022316044). The Newcastle Ottawa Scale and Cochrane Risk of Bias-2 tool were used for quality assessments and results were narratively synthesised. RESULTS We identified 3838 studies and included 18 papers published between 2007 – 2024. Most studies were on asthma (asthma=15, COPD=2, both=1) and were primarily of medium or low quality. Effectiveness and patient-centredness were the most studied outcomes with 13 studies each. Eight studies were on equity, six on efficiency, five on safety and four on timeliness. Evidence on effectiveness varied with some improvements in disease control and preventative practices, but no mortality benefits. Regarding patient-centredness, although good satisfactions rates were noted, engagement and sustained use were low. Equity impacts varied with a notable exclusion of participants with digital access barriers, whereas modest efficiency benefits were reported with improvements in care-delivery processes. Limited but positive reports regarding safety, and some improvements in time to care were also noted. Although some positive effects were noted across various quality outcomes, we were unable to draw strong conclusions given the high risk of bias across most included studies. CONCLUSIONS Patient portals may provide some benefits in chronic respiratory disease management, but more methodologically robust studies are needed to increase certainty of evidence and identify specific beneficial pathways and functions. CLINICALTRIAL PROSPERO(CRD42022316044)