Optimization of Primary Care Among Black Americans Using Patient Portals: Qualitative Study

Exploring potential drivers of patient engagement with their health data through digital platforms: A scoping review

BACKGROUND

Patient engagement when providing patient access to health data results from an interaction between the available tools and individual capabilities. The recent digital advancements of the healthcare field have altered the manifestation and importance of patient engagement. However, a comprehensive assessment of what factors contribute to patient engagement remain absent. In this review article, we synthesised the most frequently discussed factors that can foster patient engagement with their health data.

METHODS

A scoping review was conducted in MEDLINE, Embase, and Google Scholar. Relevant data were synthesized within 7 layers using a thematic analysis: (1) social and demographic factors, (2) patient ability factors, (3) patient motivation factors, (4) factors related to healthcare professionals' attitudes and skills, (5) health system factors, (6) technological factors, and (7) policy factors.

RESULTS

We identified 5801 academic and 200 Gy literature records, and included 292 (4.83%) in this review. Overall, 44 factors that can affect patient engagement with their health data were extracted. We extracted 6 social and demographic factors, 6 patient ability factors, 12 patient motivation factors, 7 factors related to healthcare professionals' attitudes and skills, 4 health system factors, 6 technological factors, and 3 policy factors.

CONCLUSIONS

Improving patient engagement with their health data enables the development of patient-centered healthcare, though it can also exacerbate existing inequities. While expanding patient access to health data is an important step towards fostering shared decision-making in healthcare and subsequently empowering patients, it is important to ensure that these developments reach all sectors of the community.

Women's experiences of using patient portals in healthcare settings: a rapid review

BACKGROUND

The integration of patient portals into health systems has the potential to increase access for women. For example, within a mental health context, women are at a higher risk of developing anxiety and depression but may experience barriers in accessing care. Therefore, the aim of this rapid review was to understand what is currently known about patient portal use among women. The objectives were (1) To discover pertinent facilitators for women when using patient portals; (2) To discern if women face individual barriers to accessing patient portals; and (3) To explore the potential role of patient portals for women's mental health care.

METHODS

A rapid review methodology was implemented using the Cochrane Rapid Reviews Methods Group, as well as a grey literature scan. Inclusion criteria included articles that focused on women's use of patient portals within healthcare settings. Four databases were searched, including Embase, MEDLINE (Ovid), CINAHL and PsycINFO in September 2023. Two independent reviewers performed screening, data extraction, and analysis.

RESULTS

This search resulted in screening 1385 titles and abstracts, and 82 articles for full-text eligibility. 15 articles were included in the review. Data were extracted and analyzed, guided by the research objectives. Facilitators to patient portal use included processes that enhanced user engagement, the provision of portal tools, and management of health care features. Barriers included health equity factors and use of medical jargon. Applications to mental health care included how use of portals eased women's anxiety and increased their sense of internal control.

CONCLUSIONS

The results of this review indicate that interrelated factors influence women's experiences with using patient portals. By understanding facilitators and barriers to portal use, and applications for mental health care, we can understand how to improve women's use of portals in the future.

Differences by Race in Outcomes of an In-Person Training Intervention on Use of an Inpatient Portal: A Secondary Analysis of a Randomized Clinical Trial

Importance

Differences in patient use of health information technologies by race can adversely impact equitable access to health care services. While this digital divide is well documented, there is limited evidence of how health care systems have used interventions to narrow the gap.

Objective

To compare differences in the effectiveness of patient training and portal functionality interventions implemented to increase portal use among racial groups.

Design, Setting, and Participants

This secondary analysis used data from a randomized clinical trial conducted from December 15, 2016, to August 31, 2019. Data were from a single health care system and included 6 noncancer hospitals. Participants were 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. Data were analyzed from September 1, 2022, to October 31, 2023.

Interventions

A 2 × 2 factorial design was used to compare the inpatient portal training intervention (touch, in-person [high] vs built-in video tutorial [low]) and the portal functionality intervention (technology, full functionality [full] vs a limited subset of functions [lite]).

Main Outcomes and Measures

Primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and use of specific portal functions. A logistic regression model was used to test the association of the estimators with the comprehensiveness use measure. Outcomes are reported as incidence rate ratios (IRRs) for the frequency outcomes or odds ratios (ORs) for the comprehensiveness outcomes with corresponding 95% CIs.

Results

Of 2892 participants, 550 (19.0%) were Black individuals, 2221 (76.8%) were White individuals, and 121 (4.2%) were categorized as other race (including African, American Indian or Alaska Native, Asian or Asian American, multiple races or ethnicities, and unknown race or ethnicity). Black participants had a significantly lower frequency (IRR, 0.80 [95% CI, 0.72-0.89]) of inpatient portal use compared with White participants. Interaction effects were not observed between technology, touch, and race. Among participants who received the full technology intervention, Black participants had lower odds of being comprehensive users (OR, 0.76 [95% CI, 0.62-0.91), but interaction effects were not observed between touch and race.

Conclusions and Relevance

In this study, providing in-person training or robust portal functionality did not narrow the divide between Black participants and White participants with respect to their inpatient portal use. Health systems looking to narrow the digital divide may need to consider intentional interventions that address underlying issues contributing to this inequity.

Trial Registration

ClinicalTrials.gov Identifier: NCT02943109.

Belonging, endurance, and resistance: Black placemaking theory in primary care

Black-Americans continue to experience pervasive health disparities. Factors contributing to increased disease risk include a general mistrust of biomedical institutions among Black Americans. The purpose of this focus group study was to identify, among Black patients who regularly seek care from a primary provider, salient themes regarding barriers to 1) receiving quality primary care; and 2) adhering to medical recommendations. We examined transcripts of eight focus groups held remotely with 29 Black patients (aged 30-60 years) who had established primary care providers. Using grounded theory and an inductive thematic analysis of the transcripts, we identified three themes (belonging, endurance, and resistance) consistent with Black placemaking theory. Our findings suggest that reducing health disparities for Black Americans will require clinical initiatives that emphasize: 1) attention to social influences on health behavior and to features of medical institutions that mark them as White spaces (belonging); 2) recognition of, as well as sensitivity to, community awareness of the systemic and interpersonal barriers to health and safety that many Black adults endure; and 3) reframing avoidant (resistant) behaviors as protective strategies among Black patients. Examining primary care in this way-through the lens of Black placemaking theory-reveals how culturally meaningful approaches to harnessing the specialized knowledge and resilience that clearly exists among many Black communities can improve health care delivery.

Telehealth uptake among middle-aged and older Americans during COVID-19: chronic conditions, social media communication, and race/ethnicity

OBJECTIVES

This study investigated whether and to what extent constructs of the protection motivation theory of health (PMT)-threat appraisal (perceived vulnerability/severity) and coping appraisal (response efficacy and self-efficacy)-are related to telehealth engagement during the COVID-19 pandemic, and how these associations differ by race/ethnicity among middle-aged and older Americans.

METHODS

Data were from the 2020 Health and Retirement Study. Multivariable ordinary least-squares regression analyses were computed adjusting for health and sociodemographic factors.

RESULTS

Some PMT constructs are useful in understanding telehealth uptake. Perceived vulnerability/severity, particularly comorbidity (b = 0.13, 95% confidence interval (CI) [0.11, 0.15], p < 0.001), and response efficacy, particularly participation in communication via social media (b = 0.24, 95% CI [0.21, 0.27], p < 0.001), were significantly and positively associated with higher telehealth uptake during the COVID-19 pandemic among middle-aged and older Americans. Non-Hispanic Black adults were more likely to engage in telehealth during the pandemic than their non-Hispanic White counterparts (b = 0.20, 95% CI [0.12, 0.28], p < 0.001). Multiple moderation analyses revealed the significant association between comorbidity and telehealth uptake was similar across racial/ethnic groups, whereas the significant association between social media communication and telehealth uptake varied by race/ethnicity. Specifically, the association was significantly less pronounced for Hispanic adults (b = -0.11, 95% CI [-0.19, -0.04], p < 0.01) and non-Hispanic Asian/other races adults (b = -0.13, 95% CI [-0.26, -0.01], p < 0.05) than it was for their non-Hispanic White counterparts.

CONCLUSION

Results suggest the potential of using social media and telehealth to narrow health disparities, particularly serving as a bridge for members of underserved communities to telehealth uptake.

Evaluation of Experiences and Attitudes of Patients Towards Patient Portal-Enabled Access to Their Health Information or Medical Records: A Qualitative Grounded Theory Study

The demand for patient-centred care and patient engagement in their healthcare has driven patient portal introduction. The widespread adoption and use of patient portals, however, has been a rather slow process in the United Kingdom. Hence, a limited number of studies have explored patient perceptions and experiences of general portal use, which forms a foundation for successful implementation of a portal. This study, therefore, focuses on the experiences and attitudes of patients regarding use of patient portals and access to their health information. It further explores various factors perceived by patients that may influence portal use and uptake. The overall findings from this study highlight positive patient perceptions of portal use. Nevertheless, it demonstrates various areas of improvement essential to ensure future success of portal implementation and acceptance.

The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

BACKGROUND AND OBJECTIVE

Recent external factors-the 21st Century Cures Act and the coronavirus disease 2019 (COVID-19) pandemic-have stimulated major changes in the patient portal landscape. The objective of this state-of-the-art review is to describe recent developments in the patient portal literature and to identify recommendations and future directions for the design, implementation, and evaluation of portals.

METHODS

To focus this review on salient contemporary issues, we elected to center it on four topics: (1) 21st Century Cures Act's impact on patient portals (e.g., Open Notes); (2) COVID-19's pandemic impact on portals; (3) proxy access to portals; and (4) disparities in portal adoption and use. We conducted targeted PubMed searches to identify recent empirical studies addressing these topics, used a two-part screening process to determine relevance, and conducted thematic analyses.

RESULTS

Our search identified 174 unique papers, 74 were relevant empirical studies and included in this review. Among these papers, we identified 10 themes within our four a priori topics, including preparing for and understanding the consequences of increased patient access to their electronic health information (Cures Act); developing, deploying, and evaluating new virtual care processes (COVID-19); understanding current barriers to formal proxy use (proxy access); and addressing disparities in portal adoption and use (disparities).

CONCLUSION

Our results suggest that the recent trends toward understanding the implications of immediate access to most test results, exploring ways to close gaps in portal adoption and use among different sub-populations, and finding ways to leverage portals to improve health and health care are the next steps in the maturation of patient portals and are key areas that require more research. It is important that health care organizations share their innovative portal efforts, so that successful measures can be tested in other contexts, and progress can continue.

The Influence of the Electronic Health Record on Achieving Equity and Eliminating Health Disparities for Children

The electronic health record (EHR) has been heralded as a transformative approach to modernizing health care and advancing health equity. Access to the EHR can facilitate shared clinical decision-making and improved communication with patients, families, and among health care providers. Recent legislative and regulatory efforts have been passed to increase the transparency as well as the initiatives to increase the meaningful use of the EHR. Yet despite these well-intended efforts, challenges to addressing health equity through the EHR persist. This article reviews three distinct challenges to addressing health equity related to the EHR. We discuss (1) both the implicit and explicit bias that exist in EHR documentation, (2) the gaps that remain between screening for social determinants of health and the effective inclusion and billing of that screening into the EHR, and (3) the disparities that exist with the use of patient portals. Addressing these three areas will enhance the opportunities to advance health equity through the use of the EHR and bring us one step closer to eliminating health disparities in pediatric health care. [Pediatr Ann. 2022;51(3):e112-e117.].