A Randomized Trial to Train Vulnerable Primary Care Patients to Use a Patient Portal

Abstract

Background Patient portals are becoming ubiquitous. Previous research has documented substantial barriers, especially among vulnerable patient subgroups such as those with lower SES or limited health literacy (LHL). We tested the effectiveness of delivering online, video-based portal training to patients in a safety net setting. Methods We created an online video curriculum about accessing the San Francisco Health Network portal, and then randomized 93 English-speaking patients with 1+ chronic diseases to receive: 1) an in-person tutorial with a research assistant or 2) link to view the videos on their own. We also examined a third, non-randomized usual care comparison group. The primary outcome was portal log-in (yes/no) 3–6 months post-training, assessed via the EHR. Secondary outcomes were self-reported attitudes and skills collected via baseline and follow-up surveys. Results Mean age was 54, 51% had LHL, 60% were non-white, 52% were female, 45% reported fair/poor health, and 76% reported daily Internet use. At follow-up, 21% logged into the portal, with no differences by arm (p=0.41), but this was higher than the overall clinic rate of 9% (p<0.01) during the same time period. We found significant pre-post improvements in self-rated portal skills (p=0.03) and eHealth literacy (p<0.01). Those with LHL were less likely to log in post-training (p<0.01). Conclusions Both modalities of online training were comparable, and neither mode enabled a majority of vulnerable patients to use portals, especially those with LHL. This suggests that portal training will need to be more intensive or portals need improved usability to meaningfully increase use among diverse patients.

Clinician Experience with Telemedicine at a Safety-net Hospital Network during COVID-19: A Cross-sectional Survey

“…22,47 For barriers in digital literacy, robust evidence exists for interventions to support individual-level patient preparation for portal access, which is likely to extend to telemedicine as well. [48][49][50][51][52] For limited English proficiency patients, dissemination of best practices for interpreter services must be standardized. 24 Finally, the design of telemedicine platforms and instructional tools must engage patients and stakeholders from vulnerable populations, applying user-centered design or other participatory methods.…”

Patient Portals: Useful for Whom and for What? A Cross-Sectional Analysis of National Survey Data

“…Improving our understanding of patients' context of use with respect to various patient portal functions is important to ensure that such tools are both usable and perceived as useful for those patients, because patient portal use may improve patient outcomes including medication adherence, appointment attendance, and patient-provider communication. 12,[46][47][48] Furthermore, identifying strategies to effectively facilitate patient portal use, including tailored patient portal education or trainings, 49,50 may be particularly important in efforts to reduce patient portal use disparities and increase the use of this important health information technology.…”

In-Home Technology Training Among Socially Isolated Older Adults: Findings From the Tech Allies Program

“…Participants who used the internet also self-reported confidence in core technology skills: (a) searching for information online and (b) using email (Lyles et al, 2019). Participants were considered confident in these basic digital skills if they felt "somewhat," "quite a bit," or "extremely" confident in both searching for information and using email, as has been done in previous studies (Lyles et al, 2019). Participants who reported never using the internet were assumed to have no confidence with these digital skills.…”