This is one of the first studies to examine a strategy to increase patient portal uptake and usage among minority, urban adolescents (a group with demonstrated preferences on communications with health-care providers). The presence of specially trained MyChart Genius staff is a feasible, effective, and patient-satisfactory method of engaging with this group of adolescents.

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BACKGROUND Although rapid diagnosis of Lyme disease is essential for effective treatment, there is concern about inappropriate testing. We conducted a prospective, cross-sectional survey of clinicians to assess the use and appropriateness of Lyme disease serologic tests (LDSTs).METHODS LDSTs performed at 2 large Wisconsin reference laboratories were systematically sampled for 12 consecutive months. A standardized questionnaire was used to gather data about the submitting clinician and the patient tested. Tests were categorized as appropriate, inappropriate, or discretionary, and associations were assessed using logistic regression analysis. A test was defi ned as inappropriate if the patient was asymptomatic, had erythema migrans, or was treated empirically, or if the test was ordered as a test of cure. RESULTSWe surveyed 303 clinicians regarding 356 LDSTs: 72 tests (20%) were appropriate, 95 (27%) were inappropriate, and 189 (53%) were discretionary. Tests were more likely to be inappropriate if they were ordered by an emergency or urgent care physician compared with other specialists (adjusted odds ratio [AOR] 5.2, 95% confi dence interval [CI], 1.3-20.6), or if preceded by a known tick bite (AOR 6.8, 95% CI, 2.6-17.6). The patient rather than the clinician requested 26% of tests, which were more likely to be inappropriate than clinicianrequested tests (crude odds ratio [COR] 5.8, 95% CI, 2.5-13.6). Tests were more likely to be patient-requested if they were ordered by an internist (AOR 2.6, 95% CI, 1.4-4.8) or if the patient was ≥40 years old (AOR 2.2, 95% CI, 1.3-3.9). CONCLUSIONS Many LDSTs are ordered inappropriately, often infl uenced by patient demand. Education of clinicians and patients about testing indications and contraindications is needed to reduce the number of inappropriate LDSTs.

Participation in the DepoText trial was associated with continued use of DMPA or a more effective contraceptive method almost 20 months after the intervention exposure ended.