Characteristics of Patients Using Different Patient Portal Functions and the Impact on Primary Care Service Utilization and Appointment Adherence: Retrospective Observational Study

Abstract

Background Patient portals are now widely available and increasingly adopted by patients and providers. Despite the growing research interest in patient portal adoption, there is a lack of follow-up studies describing the following: whether patients use portals actively; how frequently they use distinct portal functions; and, consequently, what the effects of using them are, the understanding of which is paramount to maximizing the potential of patient portals to enhance care delivery. Objective To investigate the characteristics of primary care patients using different patient portal functions and the impact of various portal usage behaviors on patients’ primary care service utilization and appointment adherence. Methods A retrospective, observational study using a large dataset of 46,544 primary care patients from University of Florida Health was conducted. Patient portal users were defined as patients who adopted a portal, and adoption was defined as the status that a portal account was opened and kept activated during the study period. Then, users were further classified into different user subgroups based on their portal usage of messaging, laboratory, appointment, and medication functions. The intervention outcomes were the rates of primary care office visits categorized as arrived, telephone encounters, cancellations, and no-shows per quarter as the measures of primary care service utilization and appointment adherence. Generalized linear models with a panel difference-in-differences study design were then developed to estimate the rate ratios between the users and the matched nonusers of the four measurements with an observational window of up to 10 quarters after portal adoption. Results Interestingly, a high propensity to adopt patient portals does not necessarily imply more frequent use of portals. In particular, the number of active health problems one had was significantly negatively associated with portal adoption (odds ratios [ORs] 0.57-0.86, 95% CIs 0.51-0.94, all P<.001) but was positively associated with portal usage (ORs 1.37-1.76, 95% CIs 1.11-2.22, all P≤.01). The same was true for being enrolled in Medicare for portal adoption (OR 0.47, 95% CI 0.41-0.54, P<.001) and message usage (OR 1.44, 95% CI 1.03-2.03, P=.04). On the impact of portal usage, the effects were time-dependent and specific to the user subgroup. The most salient change was the improvement in appointment adherence, and patients who used messaging and laboratory functions more often exhibited a larger reduction in no-shows compared to other user subgroups. Conclusions Patients differ in their portal adoption and usage behaviors, and the portal usage effects are heterogeneous and dynamic. However, there exists a lack of match in the patient portal market where patients who benefit the most from patient portals are not active portal adopters. Our findings suggest that health care delivery planners and administrators should remove the barriers of adoption for the portal beneficiaries; in addition, they should incorporate the impact of portal usage into care coordination and workflow design, ultimately aligning patients’ and providers’ needs and functionalities to effectively deliver patient-centric care.

Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review

“…The health system perspective was explored by 15 peer-reviewed [ 45 , 48 , 49 , 59 , 65 , 69 - 71 , 128 - 134 ] and 3 gray literature [ 106 , 109 , 135 ] studies, which focused on the impact of patient portals on the potential for reducing costs. The studies varied in data collection approaches (prospective observational, n=4; retrospective observational, n=9; survey methods, n=2; and mixed methods, n=3), and the evaluated portal components (portal in general, n=11; viewing laboratory results, n=1; OpenNotes, n=1; secure messaging, n=4; appointments, n=2; and care plan, n=1).…”

Patient Portal Functionalities and Patient Outcomes Among Patients With Diabetes: Systematic Review

“…A recent survey study of a patient portal with access to health care records, test results, e-messaging, and appointment booking reported that patients believed portal use helped them “avoid a clinic visit” [ 39 ]. Few studies in the literature also examined the association between patient portal use and missing medical appointments [ 39 , 40 ], which was not examined in any of the studies included in this review. The health care utilization outcomes associated with patient portal use may need further investigation as the number of studies examining these associations is limited.…”

“…First, there is some evidence that increased frequency of patient portal or patient portal functionality use could be associated with increased benefits, suggesting a dose-response relationship. Patient portal adoption does not indicate continuous use [ 40 ]. Since differences in the frequency of use may lead to inconsistencies in benefits acquired from the patient portal, studies need to account for the frequency of patient portal use as much as possible.…”

A New Method for Structured Integration of User Needs in Two Health Technology Development Projects: Action Sheets

“…bDetailed information on the conducted focus groups and the participating users can be found in separate publications. ( 30,31 )…”

“…This might affect the uptake of newly developed solutions into care delivery because they cannot become embedded into care coordination and workflow design. 30…”