1
|
Atherton H, Eccles A, Poltawski L, Dale J, Campbell J, Abel G. Investigating Patient Use and Experience of Online Appointment Booking in Primary Care: Mixed Methods Study. J Med Internet Res 2024; 26:e51931. [PMID: 38976870 PMCID: PMC11263895 DOI: 10.2196/51931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Online appointment booking is a commonly used tool in several industries. There is limited evidence about the benefits and challenges of using online appointment booking in health care settings. Potential benefits include convenience and the ability to track appointments, although some groups of patients may find it harder to engage with online appointment booking. We sought to understand how patients in England used and experienced online appointment booking. OBJECTIVE This study aims to describe and compare the characteristics of patients in relation to their use of online appointment booking in general practice and investigate patients' views regarding online appointment booking arrangements. METHODS This was a mixed methods study set in English general practice comprising a retrospective analysis of the General Practice Patient Survey (GPPS) and semistructured interviews with patients. Data used in the retrospective analysis comprised responses to the 2018 and 2019 GPPS analyzed using mixed-effects logistic regression. Semistructured interviews with purposively sampled patients from 11 general practices in England explored experiences of and views on online appointment booking. Framework analysis was used to allow for comparison with the findings of the retrospective analysis. RESULTS The retrospective analysis included 1,327,693 GPPS responders (2018-2019 combined). We conducted 43 interviews with patients with a variety of experiences and awareness of online appointment booking; of these 43 patients, 6 (14%) were from ethnic minority groups. In the retrospective analysis, more patients were aware that online appointment booking was available (581,224/1,288,341, 45.11%) than had experience using it (203,184/1,301,694, 15.61%). There were deprivation gradients for awareness and use and a substantial decline in both awareness and use in patients aged >75 years. For interview participants, age and life stage were factors influencing experiences and perceptions, working patients valued convenience, and older patients preferred to use the telephone. Patients with long-term conditions were more aware of (odds ratio [OR] 1.43, 95% CI 1.41-1.44) and more likely to use (OR 1.65, 95% CI 1.63-1.67) online appointment booking. Interview participants with long-term conditions described online appointment booking as useful for routine nonurgent appointments. Patients in deprived areas were clustered in practices with low awareness and use of online appointment booking among GPPS respondents (OR for use 0.65, 95% CI 0.64-0.67). Other key findings included the influence of the availability of appointments online and differences in the registration process for accessing online booking. CONCLUSIONS Whether and how patients engage with online appointment booking is influenced by the practice with which they are registered, whether they live with long-term conditions, and their deprivation status. These factors should be considered in designing and implementing online appointment booking and have implications for patient engagement with the wider range of online services offered in general practice.
Collapse
Affiliation(s)
- Helen Atherton
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Abi Eccles
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Leon Poltawski
- University of Exeter Medical School, Exeter, United Kingdom
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - John Campbell
- University of Exeter Medical School, Exeter, United Kingdom
| | - Gary Abel
- University of Exeter Medical School, Exeter, United Kingdom
| |
Collapse
|
2
|
Beaton M, Jiang X, Minto E, Lau CY, Turner L, Hripcsak G, Chaudhari K, Natarajan K. Using patient portals for large-scale recruitment of individuals underrepresented in biomedical research: an evaluation of engagement patterns throughout the patient portal recruitment process at a single site within the All of Us Research Program. J Am Med Inform Assoc 2024:ocae135. [PMID: 38917428 DOI: 10.1093/jamia/ocae135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/19/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE To evaluate the use of patient portal messaging to recruit individuals historically underrepresented in biomedical research (UBR) to the All of Us Research Program (AoURP) at a single recruitment site. MATERIALS AND METHODS Patient portal-based recruitment was implemented at Columbia University Irving Medical Center. Patient engagement was assessed using patient's electronic health record (EHR) at four recruitment stages: Consenting to be contacted, opening messages, responding to messages, and showing interest in participating. Demographic and socioeconomic data were also collected from patient's EHR and univariate logistic regression analyses were conducted to assess patient engagement. RESULTS Between October 2022 and November 2023, a total of 59 592 patients received patient portal messages inviting them to join the AoURP. Among them, 24 445 (41.0%) opened the message, 8983 (15.1%) responded, and 3765 (6.3%) showed interest in joining the program. Though we were unable to link enrollment data with EHR data, we estimate about 2% of patients contacted ultimately enrolled in the AoURP. Patients from underrepresented race and ethnicity communities had lower odds of consenting to be contacted and opening messages, but higher odds of showing interest after responding. DISCUSSION Patient portal messaging provided both patients and recruitment staff with a more efficient approach to outreach, but patterns of engagement varied across UBR groups. CONCLUSION Patient portal-based recruitment enables researchers to contact a substantial number of participants from diverse communities. However, more effort is needed to improve engagement from underrepresented racial and ethnic groups at the early stages of the recruitment process.
Collapse
Affiliation(s)
- Maura Beaton
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Xinzhuo Jiang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Elise Minto
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Chun Yee Lau
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Lennon Turner
- Center for Precision Medicine and Genomics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Kanchan Chaudhari
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| |
Collapse
|
3
|
Griffin JM, Kroner BL, Wong SL, Preiss L, Wilder Smith A, Cheville AL, Mitchell SA, Lancki N, Hassett MJ, Schrag D, Osarogiagbon RU, Ridgeway JL, Cella D, Jensen RE, Flores AM, Austin JD, Yanez B. Disparities in electronic health record portal access and use among patients with cancer. J Natl Cancer Inst 2024; 116:476-484. [PMID: 37930884 PMCID: PMC10919330 DOI: 10.1093/jnci/djad225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Electronic health record-linked portals may improve health-care quality for patients with cancer. Barriers to portal access and use undermine interventions that rely on portals to reduce cancer care disparities. This study examined portal access and persistence of portal use and associations with patient and structural factors before the implementation of 3 portal-based interventions within the Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium. METHODS Portal use data were extracted from electronic health records for the 12 months preceding intervention implementation. Sociodemographic factors, mode of accessing portals (web vs mobile), and number of clinical encounters before intervention implementation were also extracted. Rurality was derived using rural-urban commuting area codes. Broadband access was estimated using the 2015-2019 American Community Survey. Multiple logistic regression models tested the associations of these factors with portal access (ever accessed or never accessed) and persistence of portal use (accessed the portal ≤20 weeks vs ≥21 weeks in the 35-week study period). RESULTS Of 28 942 eligible patients, 10 061 (35%) never accessed the portal. Male sex, membership in a racial and ethnic minority group, rural dwelling, not working, and limited broadband access were associated with lower odds of portal access. Younger age and more clinical encounters were associated with higher odds of portal access. Of those with portal access, 25% were persistent users. Using multiple modalities for portal access, being middle-aged, and having more clinical encounters were associated with persistent portal use. CONCLUSION Patient and structural factors affect portal access and use and may exacerbate disparities in electronic health record-based cancer symptom surveillance and management.
Collapse
Affiliation(s)
- Joan M Griffin
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
- Robert E. and Patricia D. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Barbara L Kroner
- Center for Clinical Research, RTI International, Research Triangle Park, NC, USA
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Liliana Preiss
- Center for Clinical Research, RTI International, Research Triangle Park, NC, USA
| | - Ashley Wilder Smith
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Nicola Lancki
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J Hassett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Deborah Schrag
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
- Robert E. and Patricia D. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Roxanne E Jensen
- Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Ann Marie Flores
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
- Department of Physical Therapy and Human Movement Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jessica D Austin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
4
|
Schwartz MLB, McDonald WS, Hallquist MLG, Hu Y, McCormick CZ, Walters NL, Tsun J, Zimmerman K, Decker A, Gray C, Malinowski J, Sturm AC, Buchanan AH. Genetics Visit Uptake Among Individuals Receiving Clinically Actionable Genomic Screening Results. JAMA Netw Open 2024; 7:e242388. [PMID: 38488794 PMCID: PMC10943406 DOI: 10.1001/jamanetworkopen.2024.2388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/23/2024] [Indexed: 03/18/2024] Open
Abstract
Importance Screening unselected populations for clinically actionable genetic disease risk can improve ascertainment and facilitate risk management. Genetics visits may encourage at-risk individuals to perform recommended management, but little has been reported on genetics visit completion or factors associated with completion in genomic screening programs. Objective To identify factors associated with postdisclosure genetics visits in a genomic screening cohort. Design, Setting, and Participants This was a cohort study of biobank data in a health care system in central Pennsylvania. Participants' exome sequence data were reviewed for pathogenic or likely pathogenic (P/LP) results in all genes on the American College of Medical Genetics and Genomics Secondary Findings list. Clinically confirmed results were disclosed by phone and letter. Participants included adult MyCode biobank participants who received P/LP results between July 2015 and November 2019. Data were analyzed from May 2021 to March 2022. Exposure Clinically confirmed P/LP result disclosed by phone or letter. Main Outcomes and Measures Completion of genetics visit in which the result was discussed and variables associated with completion were assessed by electronic health record (EHR) review. Results Among a total of 1160 participants (703 [60.6%] female; median [IQR] age, 57.0 [42.1-68.5] years), fewer than half of participants (551 of 1160 [47.5%]) completed a genetics visit. Younger age (odds ratio [OR] for age 18-40 years, 2.98; 95% CI, 1.40-6.53; OR for age 41-65 years, 2.36; 95% CI, 1.22-4.74; OR for age 66-80 years, 2.60; 95% CI, 1.41-4.98 vs age ≥81 years); female sex (OR, 1.49; 95% CI, 1.14-1.96); being married (OR, 1.74; 95% CI, 1.23-2.47) or divorced (OR, 1.80; 95% CI, 1.11-2.91); lower Charlson comorbidity index (OR for score of 0-2, 1.76; 95% CI, 1.16-2.68; OR for score of 3-4, 1.73; 95% CI, 1.18-2.54 vs score of ≥5); EHR patient portal use (OR, 1.42; 95% CI, 1.06-1.89); living closer to a genetics clinic (OR, 1.64; 95% CI, 1.14-2.36 for <8.9 miles vs >20.1 miles); successful results disclosure (OR for disclosure by genetic counselor, 16.32; 95% CI, 8.16-37.45; OR for disclosure by research assistant, 20.30; 95% CI, 10.25-46.31 vs unsuccessful phone disclosure); and having a hereditary cancer result (OR, 2.13; 95% CI, 1.28-3.58 vs other disease risk) were significantly associated with higher rates of genetics visit completion. Preference to follow up with primary care was the most common reported reason for declining a genetics visit (68 of 152 patients [44.7%]). Conclusions and Relevance This cohort study of a biobank-based population genomic screening program suggests that targeted patient engagement, improving multidisciplinary coordination, and reducing barriers to follow-up care may be necessary for enhancing genetics visit uptake.
Collapse
Affiliation(s)
- Marci L. B. Schwartz
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
- Ted Rogers Centre for Heart Research, Cardiac Genome Clinic, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | | | | | - Jessica Tsun
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
| | | | - Amie Decker
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
- University of Arkansas Medical Sciences, Little Rock
| | - Celia Gray
- Phenomics and Clinical Data Core, Geisinger, Danville, Pennsylvania
| | | | - Amy C. Sturm
- Department of Genomic Health, Geisinger, Danville, Pennsylvania
- 23andMe, Sunnyvale, California
| | | |
Collapse
|
5
|
Kc S, Tewolde S, Laverty AA, Costelloe C, Papoutsi C, Reidy C, Gudgin B, Shenton C, Majeed A, Powell J, Greaves F. Uptake and adoption of the NHS App in England: an observational study. Br J Gen Pract 2023; 73:e932-e940. [PMID: 37783512 PMCID: PMC10562999 DOI: 10.3399/bjgp.2022.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 05/30/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Technological advances have led to the use of patient portals that give people digital access to their personal health information. The NHS App was launched in January 2019 as a 'front door' to digitally enabled health services. AIM To evaluate patterns of uptake of the NHS App, subgroup differences in registration, and the impact of COVID-19. DESIGN AND SETTING An observational study using monthly NHS App user data at general-practice level in England was conducted. METHOD Descriptive statistics and time-series analysis explored monthly NHS App use from January 2019-May 2021. Interrupted time-series models were used to identify changes in the level and trend of use of different functionalities, before and after the first COVID-19 lockdown. Negative binomial regression assessed differences in app registration by markers of general-practice level sociodemographic variables. RESULT Between January 2019 and May 2021, there were 8 524 882 NHS App downloads and 4 449 869 registrations, with a 4-fold increase in App downloads when the COVID Pass feature was introduced. Analyses by sociodemographic data found 25% lower registrations in the most deprived practices (P<0.001), and 44% more registrations in the largest sized practices (P<0.001). Registration rates were 36% higher in practices with the highest proportion of registered White patients (P<0.001), 23% higher in practices with the largest proportion of 15-34-year-olds (P<0.001) and 2% lower in practices with highest proportion of people with long-term care needs (P<0.001). CONCLUSION The uptake of the NHS App substantially increased post-lockdown, most significantly after the NHS COVID Pass feature was introduced. An unequal pattern of app registration was identified, and the use of different functions varied. Further research is needed to understand these patterns of inequalities and their impact on patient experience.
Collapse
Affiliation(s)
- Sukriti Kc
- Department of Primary Care and Public Health, Imperial College London
| | - Salina Tewolde
- Department of Primary Care and Public Health, Imperial College London
| | - Anthony A Laverty
- Department of Primary Care and Public Health, Imperial College London
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Claire Reidy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Bernard Gudgin
- Patient and public involvement representative and a member of the University of Oxford Advanced Research Computing board
| | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London
| | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, UK
| |
Collapse
|
6
|
Petrovskaya O, Karpman A, Schilling J, Singh S, Wegren L, Caine V, Kusi-Appiah E, Geen W. Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review. J Med Internet Res 2023; 25:e43765. [PMID: 37856174 PMCID: PMC10623227 DOI: 10.2196/43765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. OBJECTIVE This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. METHODS PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. RESULTS Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. CONCLUSIONS The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.
Collapse
Affiliation(s)
| | - Albina Karpman
- Faculty of Nursing, MacEwan University, Edmonton, AB, Canada
| | | | - Simran Singh
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Larissa Wegren
- South Health Campus, Women's Health, Calgary, AB, Canada
| | - Vera Caine
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Willow Geen
- School of Nursing, University of Victoria, Victoria, BC, Canada
| |
Collapse
|
7
|
Topp R, Greenstein J, Etnoyer-Slaski J. The effect of a mobile health App on treatment adherence and revenue at physical health clinics: a retrospective record review. JMIR Rehabil Assist Technol 2023; 10:e43507. [PMID: 36889337 PMCID: PMC10131932 DOI: 10.2196/43507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/27/2023] [Accepted: 03/05/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND A significant proportion of patients do not adhere to their prescribed course of physical therapy or self-discharge themselves from care. Adhering to prescribed physical therapy, including attending physical therapy clinic appointments, contribute to patients achieving the goals of therapy including reducing pain and increasing functioning. Online platforms have been demonstrated to be effective means for managing clinical patients with musculoskeletal pain similar to managing them in person. Behavioral change techniques introduced through digital or online platforms can reduce nonadherence with prescribed physical therapy and improve patient outcomes. The literature also indicates that a phone-based App provided to patients that includes a reward incentive gamification to complement their care contributed to a greater number of kept appointments in a physical therapy clinic. OBJECTIVE The purpose of this study was to compare the rate of provider-discharge with self-discharge and the number of clinic visits among patients attending a physical health clinic who did and did not choose to adopt a phone-based App to complement their care. A secondary purpose was to compare the revenue generated by patients attending a physical health clinic who did and did not choose to adopt a phone-based App to complement their care. METHODS A retrospective analysis of all new outpatient medical records (n=5,328) from a multisite physical health practice were evaluated between January 2018 to December 2019. Patients in the sample self-selected into the 2018 Usual Care Group, the 2019 Usual Care Group and the 2019 Kanvas App Group who downloaded the Kanvas App. Kanvas is a customized private practice App, designed for patient engagement with their specific health care provider. This App included a gamification system that provided rewards to the patient for attending their scheduled clinic appointments. According to their medical record each patient was classified as completing prescribed therapy (Provider-Discharged) or not completing their prescribed therapy (Self-Discharged). Also, extracted from each patient's medical record were the total number of clinic visits each patient attended, the total charges for services and the total payments received by the clinic per patient. RESULTS Patients in the 2019 Kanvas App Group exhibited a higher rate of provider-discharge compared to the patients who did not adopt the App. This greater rate of provider-discharges among the patients who adopted the Kanvas App likely contributed to this group attending more clinic visits (13.21+12.09) than the other study groups who did not download the App (10.72+9.80 - 11.35+11.10). This greater number of clinic visits in turn contributed to the patients who adopted the App generating more clinic charges and payments. CONCLUSIONS Future investigators need to employ more rigorous methods to confirm these findings and healthcare providers need to weigh the anticipated benefits against the cost and staff involvement in managing the Kanvas App. CLINICALTRIAL
Collapse
Affiliation(s)
- Robert Topp
- The University of Toledo, 3000 Arlington Ave, Toledo, US
| | | | | |
Collapse
|
8
|
Alsyouf A, Lutfi A, Alsubahi N, Alhazmi FN, Al-Mugheed K, Anshasi RJ, Alharbi NI, Albugami M. The Use of a Technology Acceptance Model (TAM) to Predict Patients' Usage of a Personal Health Record System: The Role of Security, Privacy, and Usability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1347. [PMID: 36674105 PMCID: PMC9859518 DOI: 10.3390/ijerph20021347] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 05/09/2023]
Abstract
Personal health records (PHR) systems are designed to ensure that individuals have access and control over their health information and to support them in being active participants rather than passive ones in their healthcare process. Yet, PHR systems have not yet been widely adopted or used by consumers despite their benefits. For these advantages to be realized, adoption of the system is necessary. In this study, we examined how self-determination of health management influences individuals' intention to implement a PHR system, i.e., their ability to actively manage their health. Using an extended technology acceptance model (TAM), the researchers developed and empirically tested a model explaining public adoption of PHRs. In total, 389 Saudi Arabian respondents were surveyed in a quantitative cross-sectional design. The hypotheses were analysed using structural equation modelling-partial least squares (SEM-PLS4). Results indicate that PHR system usage was influenced by three major factors: perceived ease of use (PEOU), perceived usefulness (PU), and security towards intention to use. PHR PEOU and PHR intention to use were also found to be moderated by privacy, whereas usability positively moderated PHR PEOU and PHR intention to use and negatively moderated PHR PU and PHR intention to use. For the first time, this study examined the use of personal health records in Saudi Arabia, including the extension of the TAM model as well as development of a context-driven model that examines the relationship between privacy, security, usability, and the use of PHRs. Furthermore, this study fills a gap in the literature regarding the moderating effects of privacy influence on PEOU and intention to use. Further, the moderating effects of usability on the relationship between PEOU, PU, and intention to use. Study findings are expected to assist government agencies, health policymakers, and health organizations around the world, including Saudi Arabia, in understanding the adoption of personal health records.
Collapse
Affiliation(s)
- Adi Alsyouf
- Department of Managing Health Services & Hospitals, Faculty of Business Rabigh, College of Business (COB), King Abdulaziz University, Jeddah 21991, Saudi Arabia
| | - Abdalwali Lutfi
- Department of Accounting, College of Business (COB), King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Applied Science Research Center, Applied Science Private University, Amman 11931, Jordan
| | - Nizar Alsubahi
- Department of Health Services and Hospitals Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Health Services Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Fahad Nasser Alhazmi
- Department of Health Services and Hospitals Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | | | - Rami J. Anshasi
- Prosthodontics Department, Faculty of Dentistry, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Nora Ibrahim Alharbi
- Department of Business Administration, College of Business Administration (CBA), University of Business and Technology (UBT), Jeddah 23435, Saudi Arabia
| | - Moteb Albugami
- Department of Management Information Systems, College of Business (COB) Rabigh, King Abdulaziz University, P.O. Box 344, Jeddah 21991, Saudi Arabia
| |
Collapse
|
9
|
Emamekhoo H, Chandereng T, Sesto ME, Luoh R, Bergeson EM, Barbosa Carroll C, Tevaarwerk AJ. Patterns of Health Portal Use by Regular Portal Users Among Patients With Cancer: Results From the UWCCC Survivorship Program. JCO Clin Cancer Inform 2023; 7:e2200119. [PMID: 36638325 PMCID: PMC10166448 DOI: 10.1200/cci.22.00119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/21/2022] [Accepted: 12/06/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE We sought to evaluate the patterns of portal usage among patients with cancer who regularly log in to the portal. These data will inform approaches to facilitate portal use among patients with cancer. PATIENTS AND METHODS We conducted a retrospective analysis of patient portal usage by patients with cancer at the University of Wisconsin Carbone Cancer Center. Our analysis focuses on patterns of portal use by regular users (≥ 2 portal logins/year, > 3 months) receiving ongoing oncology care between January 1, 2017, and December 31, 2019. Demographics, cancer characteristics, number of oncology visits per month, and portal usage data were extracted. Regular portal users were grouped and compared on the basis of their frequency of use. A linear mixed-effects model was used to determine if the frequency of oncology visits influenced the number of logins. RESULTS We identified 2076 regular portal users. The median number of portal logins/year was 72 for the entire cohort. Age and race were associated with frequency of portal logins. There was no difference in frequency of portal login on the basis of cancer type or stage. Each additional oncology office visit in a month increased the frequency of portal logins by 3.05 ± 0.11 (SE) within the same month. Messages and test result functionalities were used by 98.7% and 98.9% of the regular users, respectively. Regular users who logged in to portal more frequently used all five studied portal functionalities. CONCLUSION Patients with cancer who use portals regularly use it more in proximity to an oncology office visit and use multiple available portal functionalities. These findings can direct strategic planning to facilitate portal utilization among those not engaged with this tool.
Collapse
Affiliation(s)
- Hamid Emamekhoo
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | - Mary E. Sesto
- University of Wisconsin School of Medicine and Public Health, Madison, WI
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Rebecca Luoh
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | | |
Collapse
|
10
|
Griffin AC, Troszak LK, Van Campen J, Midboe AM, Zulman DM. Tablet distribution to veterans: an opportunity to increase patient portal adoption and use. J Am Med Inform Assoc 2022; 30:73-82. [PMID: 36269168 PMCID: PMC9748532 DOI: 10.1093/jamia/ocac195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/01/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Examine whether distribution of tablets to patients with access barriers influences their adoption and use of patient portals. MATERIALS AND METHODS This retrospective cohort study included Veterans Affairs (VA) patients (n = 28 659) who received a VA-issued tablet between November 1, 2020 and April 30, 2021. Tablets included an app for VA's My HealtheVet (MHV) portal. Veterans were grouped into 3 MHV baseline user types (non-users, inactive users, and active users) based on MHV registration status and feature use pre-tablet receipt. Three multivariable models were estimated to examine the factors predicting (1) MHV registration among non-users, (2) any MHV feature use among inactive users, and (3) more MHV use among active users post-tablet receipt. Differences in feature use during the 6 months pre-/post-tablet were examined with McNemar chi-squared tests of proportions. RESULTS In the 6 months post-tablet, 1298 (8%) non-users registered for MHV, 525 (24%) inactive users used at least one MHV feature, and 4234 (46%) active users increased feature use. Across veteran characteristics, there were differences in registration and feature use post-tablet, particularly among older adults and those without prior use of video visits (P < .01). Among active users, use of all features increased during the 6 months post-tablet, with the greatest differences in viewing prescription refills and scheduling appointments (P < .01). CONCLUSION Providing patients who experience barriers to in-person care with a portal-enabled device supports engagement in health information and management tasks. Additional strategies are needed to promote registration and digital inclusion among inactive and non-users of portals.
Collapse
Affiliation(s)
- Ashley C Griffin
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Lara K Troszak
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - James Van Campen
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Amanda M Midboe
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Donna M Zulman
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
11
|
Casacchia NJ, Rosenthal GE, O'Connell NS, Bundy R, Witek L, Wells BJ, Palakshappa D. Characteristics of Adult Primary Care Patients Who Use the Patient Portal: A Cross-Sectional Analysis. Appl Clin Inform 2022; 13:1053-1062. [PMID: 36167336 PMCID: PMC9629981 DOI: 10.1055/a-1951-3153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/23/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The patient portal allows patients to engage with their health care team beyond the clinical encounter. While portals can improve patient outcomes, there may be disparities in which patients access the portal by sociodemographic factors. Understanding the characteristics of patients who use the portal could help design future interventions to expand portal adoption. OBJECTIVES This study aimed to (1) examine the socioeconomic factors, comorbid conditions, and health care utilization among patients of a large academic primary care network who are users and non-users of the patient portal; and (2) describe the portal functions most frequently utilized. METHODS We included all adult patients at Atrium Health Wake Forest Baptist who had at least two primary care visits between 2018 and 2019. Patients' demographics, comorbidities, health care utilization, and portal function usage were extracted from the electronic health record and merged with census data (income, education, and unemployment) from the American Community Survey. A myWakeHealth portal user was defined as a patient who used a bidirectional portal function at least once during the study period. We used multivariable logistic regression to determine which patient characteristics were independently associated with being a portal user. RESULTS Of the 178,720 patients who met inclusion criteria, 32% (N = 57,122) were users of myWakeHealth. Compared to non-users, users were more likely to be 18 to 64 years of age, female, non-Hispanic White, married, commercially insured, have higher disease burden, and have lower health care utilization. Patients residing in areas with the highest educational attainment had 51% higher odds of being a portal user than the lowest (p <0.001). Among portal users, the most commonly used function was messaging clinic providers. CONCLUSION We found that patient demographics and area socioeconomic factors were associated with patient portal adoption. These findings suggest that efforts to improve portal adoption should be targeted at vulnerable patients.
Collapse
Affiliation(s)
- Nicholas J. Casacchia
- Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Gary E. Rosenthal
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Nathaniel S. O'Connell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Richa Bundy
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Lauren Witek
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Brian J. Wells
- Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| |
Collapse
|
12
|
McAlearney AS, Walker DM, Sieck CJ, Fareed N, MacEwan SR, Hefner JL, Di Tosto G, Gaughan A, Sova LN, Rush LJ, Moffatt-Bruce S, Rizer MK, Huerta TR. Effect of In-Person vs Video Training and Access to All Functions vs a Limited Subset of Functions on Portal Use Among Inpatients: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2231321. [PMID: 36098967 PMCID: PMC9471980 DOI: 10.1001/jamanetworkopen.2022.31321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/22/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Inpatient portals provide patients with clinical data and information about their care and have the potential to influence patient engagement and experience. Although significant resources have been devoted to implementing these portals, evaluation of their effects has been limited. Objective To assess the effects of patient training and portal functionality on use of an inpatient portal and on patient satisfaction and involvement with care. Design, Setting, and Participants This randomized clinical trial was conducted from December 15, 2016, to August 31, 2019, at 6 noncancer hospitals that were part of a single health care system. Patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay were eligible for participation. Data were analyzed from May 1, 2019, to March 15, 2021. Interventions A 2 × 2 factorial intervention design was used to compare 2 levels of a training intervention (touch intervention, consisting of in-person training vs built-in video tutorial) and 2 levels of portal function availability (tech intervention) within an inpatient portal (all functions operational vs a limited subset of functions). Main Outcomes and Measures The primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and patients' satisfaction and involvement with their care. Results Of 2892 participants, 1641 were women (56.7%) with a median age of 47.0 (95% CI, 46.0-48.0) years. Most patients were White (2221 [76.8%]). The median Charlson Comorbidity Index was 1 (95% CI, 1-1) and the median length of stay was 6 (95% CI, 6-7) days. Notably, the in-person training intervention was found to significantly increase inpatient portal use (incidence rate ratio, 1.34 [95% CI, 1.25-1.44]) compared with the video tutorial. Patients who received in-person training had significantly higher odds of being comprehensive portal users than those who received the video tutorial (odds ratio, 20.75 [95% CI, 16.49-26.10]). Among patients who received the full-tech intervention, those who also received the in-person intervention used the portal more frequently (incidence rate ratio, 1.36 [95% CI, 1.25-1.48]) and more comprehensively (odds ratio, 22.52; [95% CI, 17.13-29.62]) than those who received the video tutorial. Patients who received in-person training had higher odds (OR, 2.01 [95% CI, 1.16-3.50]) of reporting being satisfied in the 6-month postdischarge survey. Similarly, patients who received the full-tech intervention had higher odds (OR, 2.06 [95%CI, 1.42-2.99]) of reporting being satisfied in the 6-month postdischarge survey. Conclusions and Relevance Providing in-person training or robust portal functionality increased inpatient engagement with the portal during the hospital stay. The effects of the training intervention suggest that providing personalized training to support use of this health information technology can be a powerful approach to increase patient engagement via portals. Trial Registration ClinicalTrials.gov Identifier: NCT02943109.
Collapse
Affiliation(s)
- Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Cynthia J. Sieck
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Dayton Children’s Hospital Center for Health Equity, Dayton, Ohio
| | - Naleef Fareed
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
| | - Sarah R. MacEwan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus
| | - Jennifer L. Hefner
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Gennaro Di Tosto
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Alice Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Lindsey N. Sova
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Laura J. Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | | | - Milisa K. Rizer
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
| | - Timothy R. Huerta
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
| |
Collapse
|
13
|
Nguyen OT, Renfro CP, Hughes J, Kumar S, Alishahi Tabriz A, Hong YR, Hanna K, Feldman SS, Schlossman DM, Turner K. Patients' use of smartphone apps for health record access in 2019: A cross-sectional study. Int J Med Inform 2022; 166:104858. [PMID: 36001919 DOI: 10.1016/j.ijmedinf.2022.104858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/27/2022] [Accepted: 08/14/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The 21st Century Cures Act has expanded patients' access to portals through smartphone applications (apps). To date, the prevalence of patient portal smartphone apps use is unclear, especially on a national scale. METHODS Using the 2019 Health Information National Trends Survey, we assessed factors associated with patient portal adopters accessing their records through a smartphone app. Multivariable logistic regression models were conducted and we reported results using predicted probability. RESULTS Across a weighted sample of 75,324,288 respondents, 39 % reported using a smartphone app to access their health records. Adults with smartphone-only internet (40.0 %; 95 % CI: 35.4-33.3) were more likely to use a smartphone app compared to adults with home internet access (30.6 %; 95 % CI: 27.9-44.7). CONCLUSIONS Optimizing the implementation and delivery of patient portal content via smartphone apps may improve their reach to patients.
Collapse
Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
| | - Chelsea P Renfro
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jonathan Hughes
- Department of Clinical Medical Education, University of Tennessee Health Science Center, Memphis, TN, USA; Ascension Saint Thomas Rutherford, Murfreesboro, TN, USA; Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sajeesh Kumar
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA; Department of Oncological Sciences, University of South Florida, Tampa, FL, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, FL, USA
| | - Karim Hanna
- Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sue S Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David M Schlossman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA; Department of Oncological Sciences, University of South Florida, Tampa, FL, USA; Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| |
Collapse
|
14
|
Wang H, Manning SE, Ho AF, Sambamoorthi U. Factors Associated with Reducing Disparities in Electronic Personal Heath Records Use Among Non-Hispanic White and Hispanic Adults. J Racial Ethn Health Disparities 2022; 10:1201-1211. [PMID: 35476224 DOI: 10.1007/s40615-022-01307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/08/2022] [Accepted: 04/16/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Personal health records (PHR) use has improved individuals' health outcomes. The adoption of PHR remains low with documented racial disparities. We aim to determine factors associated with reducing racial and ethnic disparities among Hispanic adults in PHR use. METHODS Participants included non-Hispanic White (NHW) and Hispanic adults (age ≥ 18 years) enrolled in Health Information National Trends Survey in 2018 and 2019. We identified PHR use as online medical record access in the last 12 months. We considered three factors (1. accessing mHealth Apps on the phone, 2. having a usual source of care, and 3. electronically communicating (e-communication) with healthcare providers) as facilitating PHR use. Multivariable logistic regressions with replicate weights were analyzed to determine factors associated with racial/ethnic disparities in PHR use after controlling for general characteristics (i.e., sex, age, education, insurance status, and income). RESULTS A lower percentage of Hispanics than NHWs used PHR (42.0% vs. 53.5%, P < .001). When adjusted for individual general characteristics, the adjusted odds ratio (AOR) of e-communication with healthcare providers associated with PHR use was 1.49 (1.19-1.86, P < .001), AOR was 2.06 (1.62-2.6, P < .001) on accessing to mHealth App, and 2.60 (1.86-3.63, P < .001) on having a usual source of care. However, the racial difference was not statistically significant after adjusting three factors promoting PHR use (AOR = 0.90, 95% CI = 0.66, 1.22, P = .48). CONCLUSIONS Ethnic disparities were reduced when PHR use was facilitated by having a usual source of care, active e-communication, and having access to mHealth apps. Interventions focusing on these three factors may potentially reduce racial/ethnic disparities.
Collapse
Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA.
| | - Sydney E Manning
- Department of Pharmacotherapy, Texas Center for Health Disparity, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Amy F Ho
- Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX, 76104, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, Texas Center for Health Disparity, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| |
Collapse
|
15
|
Singh S, Polavarapu M, Arsene C. Changes in patient portal adoption due to the emergence of COVID-19 pandemic. Inform Health Soc Care 2022; 48:125-138. [PMID: 35473512 DOI: 10.1080/17538157.2022.2070069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Even though patient portals are recognized as a promising mechanism to support greater patient engagement, questions remain about access and utilization. This study aims to identify factors related to portal adoption in 2019 and 2020 (before and during the COVID-19). Cross-sectional data from the Health Information National Trends Survey (HINTS) cycles- 2019 HINTS 5 cycle 3 (N = 5,438) and 2020 HINTS 5 cycle 4 (N = 3,865) were analyzed using STATA-SE version 17 to factors predicting portal adoption. Next, HINTS 5 cycles 3 and 4 were pooled to identify changes in portal feature use and ease of usage among portal users, and barrier to portal use among non-users. Respondents who were college graduates, high income, and married were more likely to adopt patient portals during 2019 and 2020. Aged 75+ and Hispanic respondents reported less frequency of portal access in 2020 versus 2019. Men were more likely to adopt patient portals in 2019 versus women in 2020. Portal users were more likely to use the portal-system features in 2019 versus 2020. Portal non-users reported having multiple-health records as less of a barrier in 2020 compared to 2019. Patient engagement needs heightened attention during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Shipra Singh
- in Health Education, School for the Advancement of Interprofessional Education (Ipe), School of Population Health, College of Health & Human Services, University of ToledoHealth Education & Public Health, Health Equity Research Center (Herc), Doctoral Program, Toledo, Ohio, USA
| | | | - Camelia Arsene
- ProMedica Cancer Institute, Sylvania, Ohio, USA.,College of Medicine and Life Sciences, Department of Medicine, College of Health & Human Services, School of Population Health, University of Toledo, Toledo, Ohio, USA
| |
Collapse
|
16
|
Effect of Sociodemographic Factors on Utilization of an Online Patient Portal to Self-Schedule Screening Mammography: A Cross-Sectional Study. J Am Coll Radiol 2022; 19:866-873. [DOI: 10.1016/j.jacr.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/26/2022] [Accepted: 03/13/2022] [Indexed: 11/21/2022]
|
17
|
Nguyen OT, Hong YR, Alishahi Tabriz A, Hanna K, Turner K. Prevalence and Factors Associated with Patient-Requested Corrections to the Medical Record through Use of a Patient Portal: Findings from a National Survey. Appl Clin Inform 2022; 13:242-251. [PMID: 35196717 PMCID: PMC8866035 DOI: 10.1055/s-0042-1743236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Providing patients with medical records access is one strategy that health systems can utilize to reduce medical errors. However, how often patients request corrections to their records on a national scale is unknown. OBJECTIVES We aimed to develop population-level estimates of patients who request corrections to their medical records using national-level data. We also identified patient-level correlates of requesting corrections. METHODS We used the 2017 and 2019 Health Information National Trends Survey and examined all patient portal adopters. We applied jackknife replicate weights to develop population-representative estimates of the prevalence of requesting medical record corrections. We conducted a multivariable logistic regression analysis to identify correlates of requesting corrections while controlling for demographic factors, health care utilization patterns, health status, technology/internet use patterns, and year. RESULTS Across 1,657 respondents, 125 (weighted estimate: 6.5%) reported requesting corrections to their medical records. In unadjusted models, greater odds of requesting corrections were observed among patients who reported their race/ethnicity as non-Hispanic black (odds ratio [OR]: 2.20, 95% confidence interval [CI]: 1.10-4.43), had frequent portal visits (OR: 3.92, 95% CI: 1.51-10.23), and had entered data into the portal (OR: 7.51, 95% CI: 4.08-13.81). In adjusted models, we found greater odds of requesting corrections among those who reported frequent portal visits (OR: 3.39, 95% CI: 1.24-9.33) and those who reported entering data into the portal (OR: 6.43, 95% CI: 3.20-12.94). No other significant differences were observed. CONCLUSION Prior to the Information Blocking Final Rule in April 2021, approximately 6.5% of patients requested corrections of errors in their medical records at the national level. Those who reported higher engagement with their health, as proxied by portal visit frequency and entering data into the portal, were more likely to request corrections.
Collapse
Affiliation(s)
- Oliver T. Nguyen
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, United States,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States,Address for correspondence Oliver T. Nguyen, MSHI Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute12902 Magnolia Dr, Tampa, FL 32612-9416United States
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida, United States
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States,Department of Oncologic Sciences, University of South Florida, Tampa, Florida, United States
| | - Karim Hanna
- Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States,Department of Oncologic Sciences, University of South Florida, Tampa, Florida, United States,Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States
| |
Collapse
|
18
|
Yang R, Zeng K, Jiang Y. Prevalence, Factors, and Association of Electronic Communication Use With Patient-Perceived Quality of Care From the 2019 Health Information National Trends Survey 5-Cycle 3: Exploratory Study. J Med Internet Res 2022; 24:e27167. [PMID: 35119369 PMCID: PMC8857700 DOI: 10.2196/27167] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/25/2021] [Accepted: 11/10/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Electronic communication (e-communication), referring to communication through electronic platforms such as the web, patient portal, or mobile phone, has become increasingly important, as it extends traditional in-person communication with fewer limitations of timing and locations. However, little is known about the current status of patients' use of e-communication with clinicians and whether the use is related to the better patient-perceived quality of care at the population level. OBJECTIVE The aim of this study was to explore the prevalence of and the factors associated with e-communication use and the association of e-communication use with patient-perceived quality of care by using the nationally representative sample of the 2019 Health Information National Trends Survey 5 (HINTS 5)-Cycle 3. METHODS Data from 5438 adult responders (mean age 49.04 years, range 18-98 years) were included in this analysis. Multiple logistic and linear regressions were conducted to explore responders' personal characteristics related to their use of e-communication with clinicians in the past 12 months and how their use was related to perceived quality of care. Descriptive analyses for e-communication use according to age groups were also performed. All analyses considered the complex survey design using the jackknife replication method. RESULTS The overall prevalence of e-communication use was 60.3%, with a significantly lower prevalence in older adults (16.6%) than that in <45-year-old adults (41%) and 45-65-year-old adults (42.4%). All percentages are weighted; therefore, absolute values are not shown. American adults who used e-communication were more likely to be high school graduates (odds ratio [OR] 1.95, 95% CI 1.14-3.34; P=.02), some college degree holders (OR 3.34, 95% CI 1.84-6.05; P<.001), and college graduates or more (OR 4.89, 95% CI 2.67-8.95; P<.001). Further, people who were females (OR 1.47, 95% CI 1.18-1.82; P=.001), with a household income ≥US $50,000 (OR 1.63, 95% CI 1.23-2.16; P=.001), with more comorbidities (OR 1.22, 95% CI 1.07-1.40; P=.004), or having a regular health care provider (OR 2.62, 95% CI 1.98-3.47; P<.001), were more likely to use e-communication. In contrast, those who resided in rural areas (OR 0.61, 95% CI 0.43-0.88; P=.009) were less likely to use e-communication. After controlling for the sociodemographics, the number of comorbidities, and relationship factors (ie, having a regular provider and trusting a doctor), e-communication use was found to be significantly associated with better perceived quality of care (β=.12, 95% CI 0.02-0.22; P=.02). CONCLUSIONS This study confirmed the positive association between e-communication use and patient-perceived quality of care and suggested that policy-level attention should be raised to engage the socially disadvantaged (ie, those with lower levels of education and income, without a regular health care provider, and living in rural areas) to maximize e-communication use and to support better patient-perceived quality of care among American adults.
Collapse
Affiliation(s)
- Rumei Yang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Kai Zeng
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
19
|
Mukhopadhyay S, Basak R, Khairat S, Carney TJ. Revisiting Provider Role in Patient Use of Online Medical Records. Appl Clin Inform 2021; 12:1110-1119. [PMID: 34911125 DOI: 10.1055/s-0041-1740189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Provider encouragement for patient use of online medical record (OMR) systems is poorly understood. The study examines temporal trends and predictors of provider encouragement and the effects of encouragement on OMR use. METHODS Health Information National Trends Survey administered in 2017 and 2020 were used. Subjects were 18 to 75 years old with access to the Internet or smart devices. From 2017 and 2020, 2,558 and 3,058 subjects were included, respectively. RESULTS In 2020, 52.8% reported receiving provider encouragement within the last year for OMR use compared with 41.3% in 2017 (p < 0.001). For respondents with chronic diseases (such as diabetes, hypertension, heart, or lung diseases [CVMD]), encouragement increased from 45.5 to 57.2% (p < 0.001). Sociodemographic determinants and clinical attributes (e.g., provider office visits, cancer history, or CVMDs) significantly (p < 0.05) predicted encouragement. Among CVMD subjects, gender and visit frequency were significant predictors. OMR use within a year grew recently (73.3% in 2020 vs. 60.6% in 2017, p = 0.002) among CVMD subjects reporting encouragement. Provider encouragement was associated (p < 0.05) with secure communication and viewing results using OMRs controlling for other predictors in the overall cohort and among CVMD subjects. CONCLUSION Many respondents reported not receiving provider encouragement for OMR use. These subjects represent millions of U.S. adults, including those participating during the pandemic, with CVMDs or cancer history. Encouragement rates grew over time and was associated with demographic or disease attributes and with OMR use. Future research should assess the optimality of encouragement. Resources enabling provider encouragement should continue and help prevent disparity in health technology use.
Collapse
Affiliation(s)
| | - Ramsankar Basak
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Saif Khairat
- Carolina Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Timothy J Carney
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| |
Collapse
|
20
|
Greenstein J, Topp R, Etnoyer-Slaski J, Staelgraeve M, McNulty J. The effect of a mobile health app on adherence to physical health treatment. JMIR Rehabil Assist Technol 2021; 8:e31213. [PMID: 34655468 PMCID: PMC8686470 DOI: 10.2196/31213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Adhering to prescribed medical interventions predicts the efficacy of the treatment. In the physical health clinics, not adhering to prescribed therapy can take the form of not attending a scheduled clinic visit (no-show appointment) or prematurely terminating treatment against the advice of the provider (self-discharge). A variety of interventions, including mobile phone apps have been introduced with patients to increase their adherence with attending scheduled clinic visits. Limited research has examined the impact of a mobile phone app among patients attending a chiropractic and rehabilitation clinic visits. OBJECTIVE The purpose of this study was to compare adherence with prescribed physical health treatment among patients attending a chiropractic and rehabilitation clinic who did and did not choose to adopt a phone-based app to complement their treatment. METHODS The medical records of new patients who presented for care during 2019 and 2020 at five community-based chiropractic and rehabilitation clinics were reviewed for the number of kept and no-show appointments and if the patient was provider discharged or self-discharged. During this 24-month study 36.3% of the 4,126 patients seen in the targeted clinics had downloaded the Kanvas App to their mobile phone while the remaining patients chose not to download the app (Usual Care Group). The gamification component of the Kanvas App provided the patient with a point every time they attended their visits which could be redeemed for an incentive. RESULTS During both 2019 and 2020 respectively the Kanvas App Group were provider discharged at a greater rate than the Usual-Care Group. The Kanvas App Group kept a similar number of appointments compared to the Usual-Care Group in 2019 but kept significantly more appointments than the Usual-Care Group in 2020. During 2019 both groups exhibited a similar number of no-show appointments but in 2020 the Kanvas App Group demonstrated more no-show appointments than the Usual Care Group. When collapsed across years and self-discharged the Kanvas App Group had a greater number of kept appointments compared to the Usual Care Group. When provider discharged, both groups exhibited a similar number of kept appointments. The Kanvas App Group and the Usual Care Group were similar in the number of no-show appointments when provider discharged and when self-discharged the Kanvas App Group had more no-show appointments compared to the Usual Care Group. CONCLUSIONS Patients who did or did not have access to the Kanvas App and were provider discharged, exhibited a similar number of kept appointments and no-show appointments. When subjects were self-discharged and received the Kanvas App they exhibited 3.2 more kept appointments and .94 more no-show appointments than self-discharged Usual Care Group.
Collapse
Affiliation(s)
- Jay Greenstein
- Kaizenovate, Kaizo Clinical Research Institute, Kaizo Health, 827E Rockville Pike, Rockville, US
| | - Robert Topp
- University of Toledo, 3000 Arlington Ave, Toledo, US
| | | | | | - John McNulty
- Kaizenovate, Kaizo Clinical Research Institute, Kaizo Health, Rockville, US
| |
Collapse
|
21
|
LeLaurin JH, Nguyen OT, Thompson LA, Hall J, Bian J, Cho HD, Acharya R, Harle CA, Salloum RG. Disparities in Pediatric Patient Portal Activation and Feature Use. JAMIA Open 2021; 4:ooab086. [PMID: 34604712 PMCID: PMC8480543 DOI: 10.1093/jamiaopen/ooab086] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Disparities in adult patient portal adoption are well-documented; however, less is known about disparities in portal adoption in pediatrics. This study examines the prevalence and factors associated with patient portal activation and the use of specific portal features in general pediatrics. Materials and methods We analyzed electronic health record data from 2012 to 2020 in a large academic medical center that offers both parent and adolescent portals. We summarized portal activation and use of select portal features (messaging, records access and management, appointment management, visit/admissions summaries, and interactive feature use). We used logistic regression to model factors associated with patient portal activation among all patients along with feature use and frequent feature use among ever users (ie, ≥1 portal use). Results Among 52 713 unique patients, 39% had activated the patient portal, including 36% of patients aged 0–11, 41% of patients aged 12–17, and 62% of patients aged 18–21 years. Among activated accounts, ever use of specific features ranged from 28% for visit/admission summaries to 92% for records access and management. Adjusted analyses showed patients with activated accounts were more likely to be adolescents or young adults, white, female, privately insured, and less socioeconomically vulnerable. Individual feature use among ever users generally followed the same pattern. Conclusions Our findings demonstrate that important disparities persist in portal adoption in pediatric populations, highlighting the need for strategies to promote equitable access to patient portals.
Collapse
Affiliation(s)
- Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Oliver T Nguyen
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jaclyn Hall
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Hee Deok Cho
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ratna Acharya
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Christopher A Harle
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| |
Collapse
|
22
|
Kinney AP, Sankaranarayanan B. Effects of Patient Portal Use on Patient Satisfaction: Survey and Partial Least Squares Analysis. J Med Internet Res 2021; 23:e19820. [PMID: 34448712 PMCID: PMC8433860 DOI: 10.2196/19820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/15/2020] [Accepted: 07/13/2021] [Indexed: 01/26/2023] Open
Abstract
Background With digital delivery of health care services gaining prominence, patient portals have become a mainstay of many health care organizations. Despite the importance of patient portals, inconclusive data exist regarding the effect of patient portal use on patient satisfaction. Objective The aim of this study is to understand the relationship between the postadoptive use of patient portals and patient satisfaction outcomes. Methods Postadoptive use of patient portals has a positive relationship with the 3 dimensions of patient satisfaction, mediated by gratification, health self-awareness, and health perceptions. A total of 504 valid patient portal user responses were collected, and partial least squares analysis was performed to analyze the data. Results Patient satisfaction was captured using three dimensions: care team interaction, atmosphere, and instruction effectiveness. The results show that postadoptive use of patient portals has a positive influence on all 3 dimensions of patient satisfaction through the mediating variables of gratification, health self-awareness, and health perceptions. Specifically, postadoptive use had significant positive influence on gratification, health self-awareness, and health perceptions. Each of the 3 patient perceptions had significant positive influence on all 3 dimensions of patient satisfaction: care team interaction, atmosphere, and instruction effectiveness. Specifically, our model explained 31.8% of the care team interaction, 40.6% of the atmosphere, and 39.1% of the instruction effectiveness. Conclusions Our model shows that patient portal use can influence patient satisfaction through the mediating effects of gratification, health self-awareness, and health perception. Patient satisfaction is an important outcome for health care organizations. Therefore, by promoting effective patient portal use and fostering patient perceptions, health care organizations can improve patient satisfaction.
Collapse
Affiliation(s)
- Aaron P Kinney
- Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, United States
| | - Balaji Sankaranarayanan
- Department of Information Technology and Supply Chain Management, College of Business and Economics, University of Wisconsin - Whitewater, Whitewater, WI, United States
| |
Collapse
|
23
|
Gmunder KN, Ruiz JW, Franceschi D, Suarez MM. Factors to Effective Telemedicine Visits During the COVID-19 Pandemic: Cohort Study. JMIR Med Inform 2021; 9:e27977. [PMID: 34254936 PMCID: PMC8404776 DOI: 10.2196/27977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/05/2021] [Accepted: 07/10/2021] [Indexed: 02/01/2023] Open
Abstract
Background With COVID-19 there was a rapid and abrupt rise in telemedicine implementation often without sufficient time for providers or patients to adapt. As telemedicine visits are likely to continue to play an important role in health care, it is crucial to strive for a better understanding of how to ensure completed telemedicine visits in our health system. Awareness of these barriers to effective telemedicine visits is necessary for a proactive approach to addressing issues. Objective The objective of this study was to identify variables that may affect telemedicine visit completion in order to determine actions that can be enacted across the entire health system to benefit all patients. Methods Data were collected from scheduled telemedicine visits (n=362,764) at the University of Miami Health System (UHealth) between March 1, 2020 and October 31, 2020. Descriptive statistics, mixed effects logistic regression, and random forest modeling were used to identify the most important patient-agnostic predictors of telemedicine completion. Results Using descriptive statistics, struggling telemedicine specialties, providers, and clinic locations were identified. Through mixed effects logistic regression (adjusting for clustering at the clinic site level), the most important predictors of completion included previsit phone call/SMS text message reminder status (confirmed vs not answered) (odds ratio [OR] 6.599, 95% CI 6.483-6.717), MyUHealthChart patient portal status (not activated vs activated) (OR 0.315, 95% CI 0.305-0.325), provider’s specialty (primary care vs medical specialty) (OR 1.514, 95% CI 1.472-1.558), new to the UHealth system (yes vs no) (OR 1.285, 95% CI 1.201-1.374), and new to provider (yes vs no) (OR 0.875, 95% CI 0.859-0.891). Random forest modeling results mirrored those from logistic regression. Conclusions The highest association with a completed telemedicine visit was the previsit appointment confirmation by the patient via phone call/SMS text message. An active patient portal account was the second strongest variable associated with completion, which underscored the importance of patients having set up their portal account before the telemedicine visit. Provider’s specialty was the third strongest patient-agnostic characteristic associated with telemedicine completion rate. Telemedicine will likely continue to have an integral role in health care, and these results should be used as an important guide to improvement efforts. As a first step toward increasing completion rates, health care systems should focus on improvement of patient portal usage and use of previsit reminders. Optimization and intervention are necessary for those that are struggling with implementing telemedicine. We advise setting up a standardized workflow for staff.
Collapse
Affiliation(s)
| | - Jose W Ruiz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Dido Franceschi
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Maritza M Suarez
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| |
Collapse
|
24
|
Ekezue BF, Bushelle-Edghill J, Dong S, Taylor YJ. The effect of broadband access on electronic patient engagement activities: Assessment of urban-rural differences. J Rural Health 2021; 38:472-481. [PMID: 34101257 DOI: 10.1111/jrh.12598] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Lack of access to high-speed internet may explain disparities in the use of technologies that support electronic patient engagement (EPE). This study describes trends in how people with and without fixed broadband connectivity in urban and rural communities used EPE tools to interact with health care providers between 2014 and 2018. METHODS We linked Federal Communications Commission fixed broadband data with the Association of American Medical Colleges Consumer Survey of Health Care Access data for years 2014-2018 (n = 23,131). ZIP Codes with a 25Mbps download speed and 3Mbps upload speed were determined to have broadband connectivity access. We evaluated 6 activities involving the use of 4 EPE tools (email, text, website, chat, video, and mobile app) and the intensity of use (0 = none, 1-3 = low, 4-6 = high). Multivariate logistic and multinomial regression models were used to determine factors associated with EPE. RESULTS More than half (57.1%) of those without broadband access lived in rural areas. Overall, the intensity in the use of EPE tools increased from 2014 to 2016, then declined steadily with higher increases in use observed in urban and suburban than in rural areas. Lack of broadband access was associated with increased odds of zero intensity versus low-intensity use of EPE tools in rural areas (OR = 1.72, 95% CI: 1.42-2.09). CONCLUSIONS Inequality in broadband connectivity access may explain why rural communities lag in using various electronic tools for interacting with health care providers. Continued efforts to increase broadband connectivity in rural communities could improve their engagement with care providers.
Collapse
Affiliation(s)
- Bola F Ekezue
- Department of Accounting, Finance, Healthcare Administration, Information Systems & Business Analytics, Broadwell College of Business and Economics, Fayetteville State University, Fayetteville, North Carolina, USA
| | - Jennifer Bushelle-Edghill
- Department of Accounting, Finance, Healthcare Administration, Information Systems & Business Analytics, Broadwell College of Business and Economics, Fayetteville State University, Fayetteville, North Carolina, USA
| | - Su Dong
- Department of Accounting, Finance, Healthcare Administration, Information Systems & Business Analytics, Broadwell College of Business and Economics, Fayetteville State University, Fayetteville, North Carolina, USA
| | - Yhenneko J Taylor
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| |
Collapse
|
25
|
Association between Patient Portal use and Office Visits. J Med Syst 2021; 45:74. [PMID: 34097149 DOI: 10.1007/s10916-021-01749-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
Extant research on the relationship between portal use and office visits is mixed. Some researchers have stated that there is no correlation between the two events, others have found a positive correlation, and still others have found a negative correlation between portal use and office visits. Through the use of system-generated data from two different portal systems, we demonstrate the correlation between portal visits and office visits. We also demonstrate how this correlation differs between two institutions and across three demographic attributes. We performed a retrospective bivariate correlation analysis between portal visits and office visits. The correlation analysis was followed by an application of Fisher's z transformation of the correlation coefficients to determine significant differences in correlation across ethnicity, gender, and age. We found a positive and statistically significant correlation between portal visits and office visits among both hospital patients (n = 2,594, r = .239, p < .000) and university health service patients (n = 1,233, r = .596, p < .000). This correlation varies significantly across the dimensions of ethnicity, gender, and age. Our findings support the importance of portal use in the care continuum. Future research should aim to better understand the nuance of personal characteristics on the relationship between portal visits and office visits. Knowing these nuances can assist practitioners with further promoting patient self-engagement through portal use.
Collapse
|
26
|
Park J, Liang M, Alpert JM, Brown RF, Zhong X. The Causal Relationship Between Portal Usage and Self-Efficacious Health Information-Seeking Behaviors: Secondary Analysis of the Health Information National Trends Survey Data. J Med Internet Res 2021; 23:e17782. [PMID: 33502334 PMCID: PMC7875689 DOI: 10.2196/17782] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/25/2020] [Accepted: 12/21/2020] [Indexed: 01/26/2023] Open
Abstract
Background Patient portals have drawn much attention, as they are considered an important tool for health providers in facilitating patient engagement. However, little is known about whether the intensive use of patient portals contributes to improved management of patients’ health in terms of their confidence in acquiring health information and exercising self-care. There is a lack of randomized trials with these outcomes measured both pre- and postadoption of patient portals. Objective The aim of this study was to examine the causal relationship between the usage of patient portals and patients’ self-efficacy toward obtaining health information and performing self-care. Methods This study was a secondary data analysis that used data from a US national survey, the National Cancer Institute’s Health Information National Trends Survey 5 Cycle 1. Patient portal usage frequency was used to define the treatment. Survey items measuring self-efficacy on a Likert-type scale were selected as the main outcomes, including patients’ confidence in obtaining health information and performing self-care. To establish causality using survey data, we adopted the instrumental variables method. To determine the direction of the causal relationship in the presence of high-dimensional confounders, we further proposed a novel testing framework that employs conditional independence tests in a directed acyclic graph. The average causal effect was measured using the two-stage least squares regression method. Results We showed that frequently using patient portals improves patients’ confidence in obtaining health information. The estimand of the weighted average causal effect was 0.14 (95% CI 0.06-0.23; P<.001). This means that when increasing the portal usage intensity, for instance, from 1-2 times to 3-5 times per year, the expected average increase in confidence level measured on a Likert-type scale would be 0.14. However, we could not conclusively determine the causal effect between patient portal usage and patients’ confidence in exercising self-care. Conclusions The results support the use of patient portals and encourage better support and education to patients. The proposed statistical method can be used to exploit the potential of national survey data for causal inference studies.
Collapse
Affiliation(s)
- Jaeyoung Park
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, United States
| | - Muxuan Liang
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jordan M Alpert
- Department of Advertising, University of Florida, Gainesville, FL, United States
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Xiang Zhong
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL, United States
| |
Collapse
|
27
|
Weinberger N, Weis A, Pohlmann S, Brändle C, Zentek T, Ose D, Szecsenyi J. A New Method for Structured Integration of User Needs in Two Health Technology Development Projects: Action Sheets. Inform Health Soc Care 2021; 46:113-125. [PMID: 33406954 DOI: 10.1080/17538157.2020.1865968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
An early integration of users and stakeholders is needed for a successful innovation process. Nonetheless, the integration of users is often hard to realize - especially when dealing with persons with chronic diseases. In addition, patients or users in general often are not able to formulate the requirements in a technical manner. Therefore, even if user requirements are collected, it is not certain that the developers know or understand 'what is really wanted'. To overcome these 'gaps', we have developed so-called Action Sheets (AS). This article presents the use of AS in two projects: the development of health technologies for people with cancer (INFOPAT) and dementia (QuartrBack). Depending on the project context, group sessions were conducted with different stakeholders to identify the needs of (potential) users. Within the INFOPAT project, ten focus groups were conducted with patients, physicians and other healthcare professionals. In QuartrBack stakeholders like e.g. care professionals, technical assistance organizations and citizens participated in two focus groups and three world cafés. Their requirements were then 'fed' into the technology development by the use of AS. AS appear to be a promising tool to make user needs based on social values more tangible and implementable into technology development processes. In addition, it shows up that four phases seem to be necessary for transferring identified user and stakeholder needs into AS, which can therefore be seen as essential to translate non-technically formulated requirements into technically feasible ones. The case study shows as lessons learned that despite the successful integration of user needs, context-sensitive adjustments are still necessary.
Collapse
Affiliation(s)
- Nora Weinberger
- Institute for Technology Assessment and Systems Analysis, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Aline Weis
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabrina Pohlmann
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Claudia Brändle
- Institute for Technology Assessment and Systems Analysis, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Tom Zentek
- Center for Telemedicine e.V., Bad Kissingen, Germany
| | - Dominik Ose
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.,Department of Population Health, University of Utah, Salt Lake City, USA
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
28
|
Avdagovska M, Menon D, Stafinski T. Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review. J Med Internet Res 2020; 22:e24568. [PMID: 33289677 PMCID: PMC7755541 DOI: 10.2196/24568] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/15/2020] [Accepted: 10/28/2020] [Indexed: 01/18/2023] Open
Abstract
Background Despite extensive and continuing research in the area of patient portals, measuring the impact of patient portals remains a convoluted process. Objective This study aims to explore what is known about patient portal evaluations and to provide recommendations for future endeavors. The focus is on mapping the measures used to assess the impact of patient portals on the dimensions of the Quadruple Aim (QA) framework and the Canada Health Infoway’s Benefits Evaluation (BE) framework. Methods A scoping review was conducted using the methodological framework of Arksey and O’Malley. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) extension for scoping reviews. A systematic and comprehensive search was conducted using the Ovid platform, and the following databases were searched: Ovid MEDLINE (R) ALL (including epub ahead of print, in-process, and other nonindexed citations), EMBASE, and PsycINFO. CINAHL on the EBSCO platform and Web of Science were searched for studies published between March 2015 and June 2020. A systematic gray literature search was conducted using the Google search engine. Extracted data were tabulated based on a coding template developed to categorize the literature into themes and areas of interest. Results A total of 96 studies were included for data extraction. The studies were categorized based on the QA dimensions, with strict adherence to the definitions for each dimension. From the patients’ perspective, it was determined that most evaluations focused on benefits and barriers to access, access to test results, medication adherence, condition management, medical notes, and secure messaging. From the population perspective, the evaluations focused on the increase in population outreach, decrease in disparities related to access to care services, and improvement in quality of care. From the health care workforce perspective, the evaluations focused on the impact of patients accessing medical records, impact on workflow, impact of bidirectional secure messaging, and virtual care. From the health system perspective, the evaluations focused on decreases in no-show appointments, impact on office visits and telephone calls, impact on admission and readmission rates and emergency department visits, and impact on health care use. Overall, 77 peer-reviewed studies were mapped on the expanded version of the BE framework. The mapping was performed using subdimensions to create a more precise representation of the areas that are currently explored when studying patient portals. Most of the studies evaluated more than one subdimension. Conclusions The QA and BE frameworks provide guidance in identifying gaps in the current literature by providing a way to show how an impact was assessed. This study highlights the need to appropriately plan how the impact will be assessed and how the findings will be translated into effective adaptations.
Collapse
Affiliation(s)
- Melita Avdagovska
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Devidas Menon
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Tania Stafinski
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
29
|
Yousef CC, Thomas A, Alenazi AO, Elgadi S, Abu Esba LC, AlAzmi A, Alhameed AF, Hattan A, Almekhloof S, AlShammary MA, Alanezi NA, Alhamdan HS, Eldegeir M, Abulezz R, Khoshhal S, Masala CG, Ahmed O. Adoption of a Personal Health Record in the Digital Age: Cross-Sectional Study. J Med Internet Res 2020; 22:e22913. [PMID: 32998854 PMCID: PMC7657719 DOI: 10.2196/22913] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND As health care organizations strive to improve health care access, quality, and costs, they have implemented patient-facing eHealth technologies such as personal health records to better engage patients in the management of their health. In the Kingdom of Saudi Arabia, eHealth is also growing in accordance with Vision 2030 and its National Transformation Program framework, creating a roadmap for increased quality and efficiency of the health care system and supporting the goal of patient-centered care. OBJECTIVE The aim of this study was to investigate the adoption of the personal health record of the Ministry of National Guard Health Affairs (MNGHA Care). METHODS A cross-sectional survey was conducted in adults visiting outpatient clinics in hospitals at the Ministry of National Guard Health Affairs hospitals in Riyadh, Jeddah, Dammam, Madinah, and Al Ahsa, and primary health care clinics in Riyadh and Qassim. The main outcome measure was self-reported use of MNGHA Care. RESULTS In the sample of 546 adult patients, 383 (70.1%) reported being users of MNGHA Care. MNGHA Care users were more likely to be younger (P<.001), high school or university educated (P<.001), employed (P<.001), have a chronic condition (P=.046), use the internet to search for health-related information (P<.001), and use health apps on their mobile phones (P<.001). CONCLUSIONS The results of this study show that there is substantial interest for the use of MNGHA Care personal health record with 70% of participants self-reporting use. To confirm these findings, objective data from the portal usage logs are needed. Maximizing the potential of MNGHA Care supports patient engagement and is aligned with the national eHealth initiative to encourage the use of technology for high-quality, accessible patient-centered care. Future research should include health care provider perspectives, incorporate objective data, employ a mixed-methods approach, and use a theoretical framework.
Collapse
Affiliation(s)
- Consuela Cheriece Yousef
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abin Thomas
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed O Alenazi
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Sumaya Elgadi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pharmacy Practice, College of Pharmacy, Princess Noura Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Laila Carolina Abu Esba
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Aeshah AlAzmi
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Abrar Fahad Alhameed
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Ahmed Hattan
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Saleh Almekhloof
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Al Ahsa, Saudi Arabia
| | - Mohammed A AlShammary
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Primary Health Care, Prince Bader Housing Clinic, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Nazzal Abdullah Alanezi
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Qassim Primary Health Care Center, Ministry of National Guard-Health Affairs, Qassim, Saudi Arabia
| | - Hani Solaiman Alhamdan
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Manal Eldegeir
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatrics, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
| | - Rayf Abulezz
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Sahal Khoshhal
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Clara Glynis Masala
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Nursing, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
| | - Omaima Ahmed
- King Saud bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Hematology/Oncology/BMT, Ministry of National Guard-Health Affairs, Jeddah, Saudi Arabia
| |
Collapse
|
30
|
Alturkistani A, Qavi A, Anyanwu PE, Greenfield G, Greaves F, Costelloe C. Patient Portal Functionalities and Patient Outcomes Among Patients With Diabetes: Systematic Review. J Med Internet Res 2020; 22:e18976. [PMID: 32960182 PMCID: PMC7539164 DOI: 10.2196/18976] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/16/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patient portal use could help improve the care and health outcomes of patients with diabetes owing to functionalities, such as appointment booking, electronic messaging (e-messaging), and repeat prescription ordering, which enable patient-centered care and improve patient self-management of the disease. OBJECTIVE This review aimed to summarize the evidence regarding patient portal use (portals that are connected to electronic health care records) or patient portal functionality use (eg, appointment booking and e-messaging) and their reported associations with health and health care quality outcomes among adult patients with diabetes. METHODS We searched the MEDLINE, Embase, and Scopus databases and reported the review methodology using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three independent reviewers screened titles and abstracts, and two reviewers assessed the full texts of relevant studies and performed data extraction and quality assessments of the included studies. We used the Cochrane Collaboration Risk of Bias Tool and the National Heart, Lung and Blood Institute (NHLBI) Study Quality Assessment Tool to assess the risk of bias of the included studies. Data were summarized through narrative synthesis. RESULTS Twelve studies were included in this review. Five studies reported overall patient portal use and its association with diabetes health and health care quality outcomes. Six studies reported e-messaging or email use-associated outcomes, and two studies reported prescription refill-associated outcomes. The reported health outcomes included the associations of patient portal use with blood pressure, low-density lipoprotein cholesterol, and BMI. Few studies reported health care utilization outcomes such as office visits, emergency department visits, and hospitalizations. A limited number of studies reported overall quality of care for patients with diabetes who used patient portals. CONCLUSIONS The included studies mostly reported improved glycemic control outcomes for patients with diabetes who used patient portals. However, limitations of studying the effects of patient portals exist, which do not guarantee whether the outcomes reported are completely the result of patient portal use or if confounding factors exist. Randomized controlled trials and mixed-methods studies could help understand the mechanisms involved in health outcome improvements and patient portal use among patients with diabetes. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42019141131; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019141131. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/14975.
Collapse
Affiliation(s)
- Abrar Alturkistani
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Ambar Qavi
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Philip Emeka Anyanwu
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Geva Greenfield
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Felix Greaves
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Ceire Costelloe
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
31
|
Turner K, Clary A, Hong YR, Alishahi Tabriz A, Shea CM. Patient Portal Barriers and Group Differences: Cross-Sectional National Survey Study. J Med Internet Res 2020; 22:e18870. [PMID: 32940620 PMCID: PMC7530687 DOI: 10.2196/18870] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/22/2020] [Accepted: 08/16/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Past studies examining barriers to patient portal adoption have been conducted with a small number of patients and health care settings, limiting generalizability. OBJECTIVE This study had the following two objectives: (1) to assess the prevalence of barriers to patient portal adoption among nonadopters and (2) to examine the association between nonadopter characteristics and reported barriers in a nationally representative sample. METHODS Data from this study were obtained from the 2019 Health Information National Trends Survey. We calculated descriptive statistics to determine the most prevalent barriers and conducted multiple variable logistic regression analysis to examine which characteristics were associated with the reported barriers. RESULTS The sample included 4815 individuals. Among these, 2828 individuals (58.73%) had not adopted a patient portal. Among the nonadopters (n=2828), the most prevalent barriers were patient preference for in-person communication (1810/2828, 64.00%), no perceived need for the patient portal (1385/2828, 48.97%), and lack of comfort and experience with computers (735/2828, 25.99%). Less commonly, individuals reported having no patient portal (650/2828, 22.98%), no internet access (650/2828, 22.98%), privacy concerns (594/2828, 21.00%), difficulty logging on (537/2828, 18.99%), and multiple patient portals (255/2828, 9.02%) as barriers. Men had significantly lower odds of indicating a preference for speaking directly to a provider compared with women (odds ratio [OR] 0.75, 95% CI 0.60-0.94; P=.01). Older age (OR 1.01, 95% CI 1.00-1.02; P<.001), having a chronic condition (OR 1.83, 95% CI 1.44-2.33; P<.001), and having an income lower than US $20,000 (OR 1.61, 95% CI 1.11-2.34; P=.01) were positively associated with indicating a preference for speaking directly to a provider. Hispanic individuals had significantly higher odds of indicating that they had no need for a patient portal (OR 1.59, 95% CI 1.24-2.05; P<.001) compared with non-Hispanic individuals. Older individuals (OR 1.05, 95% CI 1.04-1.06; P<.001), individuals with less than a high school diploma (OR 3.15, 95% CI 1.79-5.53; P<.001), and individuals with a household income of less than US $20,000 (OR 2.78, 95% CI 1.88-4.11; P<.001) had significantly higher odds of indicating that they were uncomfortable with a computer. CONCLUSIONS The most common barriers to patient portal adoption are preference for in-person communication, not having a need for the patient portal, and feeling uncomfortable with computers, which are barriers that are modifiable and can be intervened upon. Patient characteristics can help predict which patients are most likely to experience certain barriers to patient portal adoption. Further research is needed to tailor implementation approaches based on patients' needs and preferences.
Collapse
Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Alecia Clary
- Center for Healthcare Transformation, Avalere Health, Washington, DC, United States
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Amir Alishahi Tabriz
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christopher M Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|