Care for oncology patients requires multidisciplinary, longitudinal coordination. Patient portals allow patients to access medical information from electronic health records (EHRs) and communicate with clinicians. This can improve treatment coordination and increase active participation in care. 1 Unfortunately, disparities in patient portal use across age, race/ ethnicity, and socioeconomic status can affect quality of care, especially in oncology. 1,2 To identify longitudinal disparities in access, we analyzed right-censored patient portal enrollment over an 8-year period.Methods | We conducted a retrospective EHR-based study of a single cancer center since its adoption of an electronic patient portal, including all encounters for all patients 18 years or older to limit data acquisition bias. The study was approved by the University of California, San Francisco institutional review board, and consent was waived for secondary research of a large number of patients, for whom risk of contact would pose a greater risk than the study. Self-reported demographic characteristics, encounters data, and portal use were extracted from the EHR. Enrollment in the patient portal over the study period was assessed using the Kaplan-Meier method and log-rank test. Characteristics associated with enrollment were assessed with the Cox proportional hazards method. The analysis was conducted in R, version
Civic health refers to the ability of a community to organize and collectively address problems that affect the well-being of its members through democratic participation. Civic health should be an integral part of the medical school curriculum because improving a community's civic health shifts the distribution of power toward patients, better enabling them to address social determinants of health that are affecting their well-being. This article details how to effectively integrate civic health curriculum into already-existing medical education frameworks, outlines how these interventions will improve both patient care and the student experience, and addresses barriers that might restrict the implementation. Civic health can be integrated into the didactic curriculum in the form of lunchtime guest lectures, panels with community organizations, and small-group discussions; it can be integrated into experiential curriculum by distributing QR codes to aid in voter registration, organizing voter registration drives, and participating in nonpartisan canvassing. This civic health content can be integrated into existing social justice curricula without massive investment or structural change. Medical students are capable and effective messengers of civic health and can affect change at all levels of training. Notably, because civic health is directly actionable, it can be a source of motivation rather than burnout for medical students. As students develop into medical professionals, the training in civic health improves their understanding of social determinants of health and enables them to play an important role in promoting civic engagement and empowering patients with the democratic tools necessary to enact social change.
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