Barriers to patient portal access among veterans receiving home‐based primary care: a qualitative study

Mishuris, Rebecca G.; Stewart, Max; Fix, Gemmae M.; Marcello, Thomas; McInnes, D. Keith; Hogan, Timothy P.; Boardman, Judith B.; Simon, Steven R.

doi:10.1111/hex.12199

Cited by 67 publications

(88 citation statements)

References 24 publications

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“…In some cases these concerns were specifically related to the need to access a PHR from a public or shared computer (Luque et al, 2013; Mishuris et al, 2014). …”

Section: Resultsmentioning

confidence: 99%

Barriers to the use of personal health records by patients: a structured review

Showell

2017

PeerJ

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IntroductionAn increasing focus on personal electronic health records (PHRs) offers healthcare benefits for patients, particularly those in undeserved and marginalised populations, who are at risk of receiving less effective healthcare, and may have worse health outcomes. However, PHRs are likely to favour text, technical and health literate users, and be less suitable for disadvantaged patients. These concerns have prompted this review of the literature, which seeks evidence about barriers to the adoption and continued use of PHRs, the nature of the evidence for those barriers, and the stage of PHR implementation where particular barriers apply.MethodsSearches in PubMed, Embase, CINAHL and ProQuest databases were used to retrieve articles published in English after 2003 in a refereed journal, or presented in a refereed conference or scientific meeting. After screening to remove items which were out of scope, the phase of the PHR implementation, the type of investigation, and PHR barriers were categorised using thematic coding.ResultsThe search retrieved 395 items; screening identified 34 in-scope publications, which provided evidence of 21 identified barriers to patient adoption and continued use of PHRs, categorised here as Individual, Demographic, Capability, Health-related, PHR or Attitudinal factors. Barriers were identified in most phases of PHR implementation, and in most types of study. A secondary outcome identified that eleven of the publications may have introduced a bias by excluding participants who were less affluent, less capable, or marginalised.ConclusionsPHR barriers can interfere with the decision to start using a PHR, with the adoption process, and with continued use, and the impact of particular barriers may vary at different phases of PHR adoption. The complex interrelationships which exist between many of the barriers is suggested in some publications, and emerges more clearly from this review. Many PHR barriers appear to be related to low socioeconomic status. A better understanding is needed of how the effect of barriers is manifested, how that effect can be countered, and how planning and implementation of PHR initiatives can make allowance for patient level barriers to PHR adoption and use, with appropriate actions to mitigate the effect of those barriers for more disadvantaged patients.

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“…In some cases these concerns were specifically related to the need to access a PHR from a public or shared computer (Luque et al, 2013; Mishuris et al, 2014). …”

Section: Resultsmentioning

confidence: 99%

Barriers to the use of personal health records by patients: a structured review

Showell

2017

PeerJ

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“…Second, eHealth technology can provide symptom management support, for example, through mobile apps [62] or live Web-based classes. The VA continues to develop its mobile apps patient portal system, and individual staff members are in an ideal position to help disseminate effective tools [63,64]. Third, providers can capitalize on veterans’ desire to use eHealth to access help when they need it.…”

Section: Discussionmentioning

confidence: 99%

How Veterans With Post-Traumatic Stress Disorder and Comorbid Health Conditions Utilize eHealth to Manage Their Health Care Needs: A Mixed-Methods Analysis

Whealin¹,

Jenchura²,

Wong³

et al. 2016

J Med Internet Res

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BackgroundMental health conditions are prevalent among US veterans and pose a number of self-management and health care navigation challenges. Post-Traumatic Stress Disorder (PTSD) with comorbid chronic medical conditions (CMCs) is especially common, in both returning Iraq or Afghanistan and earlier war-era veterans. Patient-facing electronic health (eHealth) technology may offer innovative strategies to support these individuals’ needs.ObjectiveThis study was designed to identify the types of eHealth tools that veterans with PTSD and comorbid CMCs use, understand how they currently use eHealth technology to self-manage their unique health care needs, and identify new eHealth resources that veterans feel would empower them to better manage their health care.MethodsA total of 119 veterans with PTSD and at least one CMC who have used the electronic personal health record system of the US Department of Veterans Affairs (VA) responded to a mailed survey about their chronic conditions and preferences related to the use of technology. After the survey, 2 focus groups, stratified by sex, were conducted with a subgroup of patients to explore how veterans with PTSD and comorbid CMCs use eHealth technology to support their complex health care needs. Focus groups were transcribed verbatim and analyzed using standard content analysis methods for coding textual data, guided by the “Fit between Individual, Task, and Technology” framework.ResultsSurvey respondents had a mean age of 64.0 (SD 12.0) years, 85.1% (97/114) were male, 72.4% (84/116) were white, and 63.1% (70/111) had an annual household income of < US $50,000. Mean score on a measure of eHealth literacy was 27.7 (SD 9.8). Of the respondents, 44.6% (50/112) used health-related technology 1 to 3 times per month and 21.4% (24/112) used technology less than once per month. Veterans reported using technology most often to search for health information (78.9%, 90/114), communicate with providers (71.1%, 81/114), and track medications (64.9%, 74/114). Five major themes emerged that describe how eHealth technology influences veterans with PTSD and comorbid CMCs: (1) interactions with social support, (2) condition management, (3) access to and communication with providers, (4) information access, and (5) coordination of care.ConclusionsThe “Fit between Individual, Task, and Technology” model provided a useful framework to examine the clinical tasks that arose for veterans and their resourceful adoption of eHealth tools. This study suggests that veterans who use the Web are eager to incorporate eHealth technology into their care and self-management activities. Findings illustrate a number of ways in which the VA and eHealth technology developers can refine existing applications, develop new resources, and better promote tools that address challenges experienced by veterans with PTSD and comorbid CMCs.

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“…Barriers which were identified by both patients and clinic staff were included in the overall summation of barriers. (Anderson, 2004) Telephone interview survey 3,000 (Atreja et al, 2005) Focus groups/interviews with clinic staff; observation - (Butler et al, 2013) Telephone interviews with patients 404 (Cho et al, 2010) Postal survey questionnaire - (Chrischilles et al, 2014) Mixed methods: user-centred design with evaluation; questionnaire 15,000 1,075 (Crabb, Rafie & Weingardt, 2011) Interview survey 75 (Emani et al, 2012) Postal survey questionnaire 1,500 (Fuji, Abbott & Galt, 2014) Interviews with trained users 59 (Goel et al, 2011a) Telephone interviews with non adopters - (Greenhalgh et al, 2008) Mixed methods: Interviews/focus groups -103/67 (Hall et al, 2014) Trial of result communication via PHR 66 (Hilton et al, 2012) Online survey (within supported PHR use) 2,871 (Kim et al, 2009) Mixed methods: Paper questionnaire, analysis of user logs 330 (Kruse et al, 2012) Interviews about internet use 713 (Lober et al, 2006) Analysis of data about PHR use 170 (McCleary-Jones et al, 2013) Interviews 350 (Mishuris et al, 2014) Semistructured interviews with patients - (Roblin et al, 2009) Paper survey with online option (nonadopters)…”

Section: Discussionmentioning

confidence: 99%

“…Patient concerns about privacy or confidentiality of the personal health information stored in a PHR were reported in seven studies (Anderson, 2004;McCleary-Jones et al, 2013). In some cases these concerns were specifically related to the need to access a PHR from a public or shared computer (Luque et al, 2013;Mishuris et al, 2014).…”

Section: Privacy and Confidentiality Concernsmentioning

confidence: 99%

Peer Review #1 of "Barriers to the use of personal health records by patients: a structured review (v0.1)"

2017

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An increasing focus on personal electronic health records (PHRs) offers healthcare benefits for patients, particularly those in undeserved and marginalised populations, who are at risk of receiving less effective healthcare, and may have worse health outcomes. However, PHRs are likely to favour text, technical and health literate users, and be less suitable for disadvantaged patients. These concerns have prompted this review of the literature, which seeks evidence about barriers to the adoption and continued use of PHRs, the nature of the evidence for those barriers, and the stage of PHR implementation where particular barriers apply. Methods: Searches in PubMed, Embase, CINAHL and ProQuest databases were used to retrieve articles published in English after 2003 in a refereed journal or presented in a refereed conference or scientific meeting. After screening to remove items which were out of scope, the phase of the PHR implementation, the type of investigation, and PHR barriers were categorised using thematic coding. Results: The search retrieved 395 items; screening identified 34 in-scope publications, which provided evidence of 21 identified barriers to patient adoption and continued use of PHRs, categorised here as Individual, Demographic, Capability, Health-related, PHR or Attitudinal factors. Barriers were identified in most phases of PHR implementation, and in most types of study. A secondary outcome identified that eleven of the publications may have introduced a bias by excluding participants who were less affluent, less capable, or marginalised. Conclusions: PHR barriers can interfere with the decision to start using a PHR, with the adoption process, and with continued use, and the impact of particular barriers may vary at different phases of PHR adoption. The complex interrelationships which exist between many of the barriers is suggested in some publications, and emerges more clearly from this review. Many PHR barriers appear to be related to low socioeconomic status. A better understanding is needed of how the effect of barriers is manifested, how that that effect can be countered, and how planning and implementation of PHR initiatives can make allowance for patient level barriers to PHR adoption and use, with appropriate actions to mitigate the effect of those barriers for more disadvantaged patients.

show abstract

Barriers to patient portal access among veterans receiving home‐based primary care: a qualitative study

Cited by 67 publications

References 24 publications

Barriers to the use of personal health records by patients: a structured review

Barriers to the use of personal health records by patients: a structured review

How Veterans With Post-Traumatic Stress Disorder and Comorbid Health Conditions Utilize eHealth to Manage Their Health Care Needs: A Mixed-Methods Analysis

Peer Review #1 of "Barriers to the use of personal health records by patients: a structured review (v0.1)"

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