A Cross-Sectional Study of Barriers to Personal Health Record Use among Patients Attending a Safety-Net Clinic

Abstract

BackgroundPersonal health records (PHR) may improve patients' health by providing access to and context for health information. Among patients receiving care at a safety-net HIV/AIDS clinic, we examined the hypothesis that a mental health (MH) or substance use (SU) condition represents a barrier to engagement with web-based health information, as measured by consent to participate in a trial that provided access to personal (PHR) or general (non-PHR) health information portals and by completion of baseline study surveys posted there.MethodsParticipants were individually trained to access and navigate individualized online accounts and to complete study surveys. In response to need, during accrual months 4 to 12 we enhanced participant training to encourage survey completion with the help of staff. Using logistic regression models, we estimated odds ratios for study participation and for survey completion by combined MH/SU status, adjusted for levels of computer competency, on-study training, and demographics.ResultsAmong 2,871 clinic patients, 70% had MH/SU conditions, with depression (38%) and methamphetamine use (17%) most commonly documented. Middle-aged patients and those with a MH/SU condition were over-represented among study participants (N = 338). Survey completion was statistically independent of MH/SU status (OR, 1.85 [95% CI, 0.93–3.66]) but tended to be higher among those with MH/SU conditions. Completion rates were low among beginner computer users, regardless of training level (<50%), but adequate among advanced users (>70%).ConclusionsAmong patients attending a safety-net clinic, MH/SU conditions were not barriers to engagement with web-based health information. Instead, level of computer competency was useful for identifying individuals requiring substantial computer training in order to fully participate in the study. Intensive on-study training was insufficient to enable beginner computer users to complete study surveys.

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“…There may be several reasons for this, including differences in scheduling personnel for different clinics, patient access to the internet, computer literacy, and psychosocial factors. Computer illiteracy (Hilton et al, 2012; Simon et al, 2008) and the inability to access the internet at home (Simon et al, 2008) are associated with inability to engage in web-based health information. However, other research has shown that patients living in either suburban or urban areas were equally likely to access the internet, even though suburban residents were more likely to own a computer and urban residents had a higher odds of being uninsured (Bond et al, 2012).…”

“…Household income cannot always predict internet use (Appleby-Tagoe et al, 2012; Bond et al, 2012; Simon et al, 2008). Research has shown that mental health issues and substance use have not been barriers to online health information either (Hilton et al, 2012). …”

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“…17 Mental health and substance abuse issues did not seem to affect a participants' ability to access information online 18 . In addition, innovative methods of delivering ePHR though an Apple iPod device were accepted by participants and resulted in greater self-efficacy for self-care.…”

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“…Fostering patient use of technology for self-management of chronic diseases could result in decreased demand on clinicians in primary care environments. Several studies have shown the acceptability of utilizing ePHRs in HIV primary care clinics (16, 17). In these studies, young Caucasian men found the ePHR to be a useful tool in managing their HIV care, but the studies were not able to enroll a more diverse racial or gender sample.…”

“…In these studies, young Caucasian men found the ePHR to be a useful tool in managing their HIV care, but the studies were not able to enroll a more diverse racial or gender sample. Investigators of another study found that substance use itself was not a barrier to completing online health related surveys through an ePHR in an urban HIV clinic sample (16). A computer-based SBIRT intervention could be a feasible method for addressing substance use in an HIV primary care clinic.…”