An Untapped Potential in Primary Care: Semi-Structured Interviews with Clinicians on How Patient Portals Will Work for Caregivers in the Safety Net

Abstract

Background Patients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these patients (ie, Medicaid recipients, older patients, patients with limited English proficiency) in navigating health systems, and provider support of the use of patient portals among these groups may also facilitate caregivers’ use of their patients’ portal. Objective Because safety net providers work closely with caregivers to care for their patients, we used qualitative methods to explore safety net providers’ perspectives on portal use among caregivers for their patients, especially as there is limited literature about caregivers’ use of portals in the safety net. Methods We conducted 45- to 60-min semistructured telephone interviews with providers from three large California safety-net health systems. The interviews focused on providers’ experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. A total of three coders analyzed the interview transcripts using both deductive and inductive approaches and established a consensus regarding major themes. Results Of the 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership or administrative role. We described themes highlighting providers’ recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement. Conclusions Providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. They noted that caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers’ interest and ability to access portals across barriers in health and digital literacy, and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security.

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.…”

Examining How Internet Users Trust and Access Electronic Health Record Patient Portals: Survey Study

“…However, modern health technology features such as EHR portals may potentially provide significant benefits for specific groups of people with specific clinical needs. For example, there may be substantial benefits for the elderly, who may need to track their health records more frequently owing to multiple complex health conditions [ 43 , 44 ]. It is necessary for future research studies to specifically target groups of patient portal users (eg, older individuals and individuals with specific health conditions) and nonusers.…”

“…We could see that emerging methods like text messaging through EHR portals and traditional methods like telephone calls are commonly used when our participants had questions for their health care providers. Although health care providers believe that the use of EHR portals can positively impact information delivery and improve patient-provider communication according to a recent study [ 44 ], EHR portals are still not widely used for communication, and there are several opportunities to improve messaging features.…”

Caregiver engagement practices in National Cancer Institute Clinical Oncology Research Program settings: Implications for research to advance the field

“…These findings could Cancer February 15, 2021 reflect practice groups' recognition of the critical role cancer caregivers play in facilitating care with vulnerable populations. [38][39][40] However, additional research is warranted to describe the specific ways practices engage and care for caregivers, including the depth and timing of assessment and services, as well as reimbursements amenable to service provision.…”