Revisiting Provider Role in Patient Use of Online Medical Records

Physician Deserts: Navigating the Texas Terrain of Provider Supply and Demand with GIS Mapping

Background: Rural health disparities in Texas impact population health due to limited healthcare access, insurance, and transportation challenges, especially in medically underserved areas. A shortage of specialists in rural regions worsens these issues, leading to increased morbidity and mortality rates. Objective: Our research aimed to address a knowledge gap by investigating the availability of three medical specialists-cardiologists, pulmonologists, and endocrinologists-in rural counties of Texas and identifying areas where access to healthcare is limited. Methods: Utilizing data from regional, state, and federal sources, the analysis geocoded specialist locations and created GIS maps to visualize the distribution of specialists across Texas's 254 counties. Physician demand was calculated by considering disease incidence and population size, resulting in a county-level physician availability index to highlight areas with shortages. Results: Our findings demonstrate a significant deficiency of cardiologists in 196 counties when considering a maximum reasonable travel distance of 50 miles. Comparable deficiencies were observed for pulmonologists and endocrinologists, with western rural counties predominantly comprising the deficiency areas for each specialty. These results emphasize a significant rural-urban disparity concerning access to the three investigated health specialists. Conclusions: Addressing geographic disparities can reduce health inequities, improve rural healthcare access, and promote a more equitable healthcare system across Texas. Solutions may include incentives for specialists to work in underserved areas, expanded telemedicine services, and transportation assistance.

The Effect of Using a Client-Accessible Health Record on Perceived Quality of Care: Interview Study Among Parents and Adolescents

BACKGROUND

Patient-accessible electronic health records (PAEHRs) are assumed to enhance the quality of care, expressed in terms of safety, effectiveness, timeliness, person centeredness, efficiency, and equity. However, research on the impact of PAEHRs on the perceived quality of care among parents, children, and adolescents is largely lacking. In the Netherlands, a PAEHR (Iuvenelis) was developed for preventive child health care and youth care. Parents and adolescents had access to its full content, could manage appointments, ask questions, and comment on written reports.

OBJECTIVE

This study aims to assess whether and how using this PAEHR contributes to perceived quality of care from a client's perspective.

METHODS

We chose a qualitative design with a phenomenological approach to explore how parents and adolescents perceived the impact of using a PAEHR on quality of care. In-depth interviews that simultaneously included 1 to 3 people were conducted in 2021. In total, 20 participants were included in the study, representing parents and adolescents, both sexes, different educational levels, different native countries, and all participating municipalities. Within this group, 7 of 13 (54%) parents had not previously been informed about the existence of a client portal. Their expectations of using the client portal, in relation to quality of care, were discussed after a demonstration of the portal.

RESULTS

Parents and adolescents perceived that using Iuvenelis contributed to the quality of care because they felt better informed and more involved in the care process than before the introduction of Iuvenelis. Moreover, they experienced more control over their health data, faster and simpler access to their health information, and found it easier to manage appointments or ask questions at their convenience. Parents from a migratory background, among whom 6 of 7 (86%) had not previously been informed about the portal, expected that portal access would enhance their understanding of and control over their care processes. The parents expressed concerns about equity because parents from a migratory background might have less access to the service. Nevertheless, portal usability was regarded as high. Furthermore, both parents and adolescents saw room for improvement in the broader interdisciplinary use of Iuvenelis and the quality of reporting.

CONCLUSIONS

Using Iuvenelis can contribute to the client-experienced quality of care, more specifically to perceived person centeredness, timeliness, safety, efficiency, and integration of care. However, some quality aspects, such as equity, still need addressing. In general, client information about the portal needs to be improved, specifically focusing on people in vulnerable circumstances, such as those from migratory backgrounds. In addition, to maximize the potential benefit of using Iuvenelis, stimulating a person-centered attitude among professionals is important. Considering the small number of adolescent participants (n=7), adding quantitative data from a structured survey could strengthen the available evidence.

Mapping the Heartbeat of America with ChatGPT-4: Unpacking the Interplay of Social Vulnerability, Digital Literacy, and Cardiovascular Mortality in County Residency Choices

Cardiovascular disease remains a leading cause of morbidity and mortality in the United States (US). Although high-quality data are accessible in the US for cardiovascular research, digital literacy (DL) has not been explored as a potential factor influencing cardiovascular mortality, although the Social Vulnerability Index (SVI) has been used previously as a variable in predictive modeling. Utilizing a large language model, ChatGPT4, we investigated the variability in CVD-specific mortality that could be explained by DL and SVI using regression modeling. We fitted two models to calculate the crude and adjusted CVD mortality rates. Mortality data using ICD-10 codes were retrieved from CDC WONDER, and the geographic level data was retrieved from the US Department of Agriculture. Both datasets were merged using the Federal Information Processing Standards code. The initial exploration involved data from 1999 through 2020 (n = 65,791; 99.98% complete for all US Counties) for crude cardiovascular mortality (CCM). Age-adjusted cardiovascular mortality (ACM) had data for 2020 (n = 3118 rows; 99% complete for all US Counties), with the inclusion of SVI and DL in the model (a composite of literacy and internet access). By leveraging on the advanced capabilities of ChatGPT4 and linear regression, we successfully highlighted the importance of incorporating the SVI and DL in predicting adjusted cardiovascular mortality. Our findings imply that just incorporating internet availability in the regression model may not be sufficient without incorporating significant variables, such as DL and SVI, to predict ACM. Further, our approach could enable future researchers to consider DL and SVI as key variables to study other health outcomes of public-health importance, which could inform future clinical practices and policies.

Association Between Patient Portal Use and Perceived Patient-Centered Communication Among Adults With Cancer: Cross-sectional Survey Study

BACKGROUND

Patient-centered communication (PCC) plays a vital role in effective cancer management and care. Patient portals are increasingly available to patients and hold potential as a valuable tool to facilitate PCC. However, whether more frequent use of patient portals is associated with increased perceived PCC and which mechanisms might mediate this relationship have not been fully studied.

OBJECTIVE

The goal of this study was to investigate the association between the frequency of access of patient portals and perceived PCC in patients diagnosed with cancer. We further sought to examine whether this association was mediated by patients' self-efficacy in health information-seeking.

METHODS

We used data from the Health Information National Trend Survey 5 (HINTS 5) cycle 3 (2019) and cycle 4 (2020). This analysis includes 1222 individuals who self-reported having a current or past diagnosis of cancer. Perceived PCC was measured with a 7-item HINTS 5-derived scale and classified as low, medium, or high. Patient portal use was measured by a single item assessing the frequency of use. Self-efficacy about health information-seeking was assessed with a 1-item measure assessing confidence in obtaining health information. We used adjusted multinomial logistic regression models to estimate relative risk ratios (RRRs)/effect sizes of the association between patient portal use and perceived PCC. Mediation by health information self-efficacy was investigated using the Baron and Kenny and Karlson-Holm-Breen methods.

RESULTS

A total of 54.5% of the sample reported that they had not accessed their patient portals in the past 12 months, 12.6% accessed it 1 to 2 times, 24.8% accessed it 3 to 9 times, and 8.2% accessed it 10 or more times. Overall, the frequency of accessing the patient portal was marginally associated (P=.06) with perceived PCC in an adjusted multinominal logistic regression model. Patients who accessed their patient portal 10 or more times in the previous 12 months were almost 4 times more likely (RRR 3.8, 95% CI 1.6-9.0) to report high perceived PCC. In mediation analysis, the association between patient portal use and perceived PCC was attenuated adjusting for health information-seeking self-efficacy, but those with the most frequent patient portal use (10 or more times in the previous 12 months) were still almost 2.5 times more likely to report high perceived PCC (RRR 2.4, 95% CI 1.1-5.6) compared to those with no portal use.

CONCLUSIONS

Increased frequency of patient portal use was associated with higher PCC, and an individual's health information-seeking self-efficacy partially mediated this association. These findings emphasize the importance of encouraging patients and providers to use patient portals to assist in patient-centeredness of cancer care. Interventions to promote the adoption and use of patient portals could incorporate strategies to improve health information self-efficacy.

Health Information Technology Use among Chronic Disease Patients: An Analysis of the United States Health Information National Trends Survey

BACKGROUND

Chronic disease is the leading cause of mortality in the United States. Health information technology (HIT) tools show promise for improving disease management.

OBJECTIVES

This study aims to understand the following: (1) how self-perceptions of health compare between those with and without disease; (2) how HIT usage varies between chronic disease profiles (diabetes, hypertension, cardiovascular disease, pulmonary disease, depression, cancer, and comorbidities); (3) how HIT trends have changed in the past 6 years; and (4) the likelihood that a given chronic disease patient uses specific HIT tools.

METHODS

The Health Information National Trends Survey (HINTS) inclusive of 2014 to 2020 served as the primary data source with statistical analysis completed using Stata. Bivariate analyses and two-tailed t-tests were conducted to compare self-perceived health and HIT usage to chronic disease. Logistic regression models were created to examine the odds of a specific patient using various forms of HIT, controlling for demographics and comorbidities.

RESULTS

Logistic regression models controlling for sociodemographic factors and comorbidities showed that pulmonary disease, depression, and cancer patients had an increased likelihood of using HIT tools, for example, depression patients had an 81.1% increased likelihood of looking up health information (p < 0.0001). In contrast, diabetic, high blood pressure, and cardiovascular disease patients appeared to use HIT tools at similar rates to patients without chronic disease. Overall HIT usage has increased during the timeframe examined.

CONCLUSION

This study demonstrates that certain chronic disease cohorts appear to have greater HIT usage than others. Further analysis should be done to understand what factors influence patients to utilize HIT which may provide additional insights into improving design and user experience for other populations with the goal of improving management of disease. Such analyses could also establish a new baseline to account for differences in HIT usage as a direct consequence of the novel coronavirus disease 2019 (COVID-19) pandemic.