Patient and provider perspectives on the use of patient portals during pregnancy and the postpartum period.

INTRODUCTION: Interest in the use of patient portals to support prenatal and postpartum care is growing. This study was conducted to understand patient and provider perspectives about the impact of portal use during pregnancy and the postpartum period. METHODS: Interviews were conducted with 30 pregnant or postpartum patients and 15 obstetric care providers at an academic medical center that offers its patients access to an outpatient portal. Interview transcripts were analyzed deductively and inductively to categorize findings and identify emergent themes. RESULTS: Patients and providers described how use of a patient portal during pregnancy and postpartum impacted communication (by supporting convenient communication and access to information), care processes (by aiding appointment attendance and helping with medication management), and care experience (by reducing anxiety and promoting patient involvement). Interviewees provided suggestions to improve patient portal use in obstetric care including using portals to increase access to educational materials and supportive resources, to collect patient-generated data, and to increase patient involvement in postpartum care. DISCUSSION: Patient portals have particular value for patients' use during pregnancy and the postpartum period due to the frequency of healthcare visits and the heightened attention to one's health during this time. There are opportunities to tailor portal content and functions to patients' needs to improve communication, care processes, and care experiences for this patient population. Further improving the functionality of patient portals for patients' use during pregnancy and the postpartum period has the potential to positively impact patient experiences and health outcomes.

Sleep-Related Eating Disorder (SRED): Paradoxical Effect of Clonazepam.

ABSTRACT: A 9-year-old boy with primary myoclonus dystonia with comorbid severe attention deficit hyperactive disorder (ADHD) also had sleep onset and maintenance insomnia. Polysomnography showed features of non-rapid eye movement parasomnia. Daily bedtime clonidine helped sleep and hyperactivity. ADHD symptoms improved with 40 mg daily lisdexamphetamine mesylate. As the myoclonus and dystonia symptoms progressed, clonazepam was initiated at a dose of 0.5 mg daily at bedtime. It was anticipated that clonazepam would also improve parasomnia. Concomitant with the initiation of clonazepam, he developed a sleep-related eating disorder (SRED) continuing almost throughout the night. The symptoms went away upon stopping clonazepam. This is the first description of clonazepam producing SRED though it is the treatment of choice for this disorder.