Disparities in Patient Portal Use Among Adults With Chronic Conditions

Abstract

ImportanceDisparities in patient access and use of health care portals have been documented. Limited research has evaluated disparities in portal use during and after the COVID-19 pandemic.ObjectiveTo assess prevalence of health care portal use before, during, and after the most restrictive phase of the pandemic (2019-2022) among the COVID-19 & Chronic Conditions (C3) cohort and to investigate any disparities in use by sociodemographic factors.Design, Setting, and ParticipantsThis cohort study uses data from the C3 study, an ongoing, longitudinal, telephone-based survey of participants with multiple chronic conditions. Participants were middle aged and older-adult primary care patients who had an active portal account, recruited from a single academic medical center in Chicago, Illinois, between 2019 and 2022. Data were analyzed between March and June 2022.Main Outcomes and MeasuresOutcomes of portal use (ie, number of days of portal login by year) were recorded for all study participants by the electronic data warehouse. All parent studies had uniform sociodemographic data and measures of social support, self-efficacy, health literacy, and health activation.ResultsOf 536 participants (mean [SD] age, 66.7 [12.0] years; 336 [62.7%] female), 44 (8.2%) were Hispanic or Latinx, 142 (26.5%) were non-Hispanic Black, 322 (60.1%) were non-Hispanic White, and 20 individuals (3.7%) identified as other race, including Asian, Native American or Alaskan Native, and self-reported other race. In multivariable analyses, portal login activity was higher during the 3 years of the COVID-19 pandemic compared with the 2019 baseline. Higher portal login activity was associated with adequate health literacy (incidence rate ratio [IRR], 1.51; 95% CI, 1.18-1.94) and multimorbidity (IRR, 1.38; 95% CI, 1.17-1.64). Lower portal activity was associated with older age (≥70 years: IRR, 0.69; 95% CI, 0.55-0.85) and female sex (IRR, 0.77; 95% CI, 0.66-0.91). Compared with non-Hispanic White patients, lower portal activity was observed among Hispanic or Latinx patients (IRR, 0.66; 95% CI, 0.49-0.89), non-Hispanic Black patients (IRR, 0.68; 95% CI, 0.56-0.83), and patients who identified as other race (IRR, 0.42; 95% CI, 0.28-0.64).Conclusions and RelevanceThis cohort study using data from the C3 study identified changes in portal use over time and highlighted populations that had lower access to health information. The COVID-19 pandemic was associated with an increase in portal use. Sociodemographic disparities by sex and age were reduced, although disparities by health literacy widened. A brief validated health literacy measure may serve as a useful digital literacy screening tool to identify patients who need further support.

Disparities in Status, Patterns, and Preferences of Internet Medical Services Utilization for Patients During the Post-COVID-19 Pandemic Period in China: Evidence from Provincial Field and National Online Surveys

“…The prevalence of IMSU (39.43% with the provincial eld survey data) reported in our results was similar to the latest data reported in Health Information National Trends Survey (HINTS) in the U.S. (39.3%), and were consistent with prior literature on digital health inequities among patients with inferior demographic (e.g., gerontal patients) and socio-economic factors (e.g., educated at basic education level), as well as increased IMSU accessed among patients with poorer health status (e.g., suffering multi chronic diseases) , but not for gender in this study [13,20,25,[27][28][29][30]. We also found that, the respondents from the national online survey with superior demographic and socio-economic factors, but poorer health status than those from the provincial eld survey.…”

“…However, the respondents with superior demographic (e.g., aged below 60 years old) and socio-economic factors (e.g., higher annual disposable income) from the national online survey were more likely to be deeply involved in IMSU (e.g., mental diseases: 374 times with 10.44%; telediagnosis: 378 times with 8.23%), which were consistent with previous studies [30][31][32][33][34]. Prior research has also indicated that the patterns of IMSU would be deepen in the patients with a chronic condition, nevertheless, in this study, patients suffering chronic diseases were less accessed to IMSU that those not suffering (35.59% vs. 40.56%) based on the provincial eld survey data, and patients suffering chronic diseases accessed to IMSU at a high frequency was lower than that at a low frequency (29.86% vs. 34.45%) based on the national online survey data [13,20,32,[35][36][37][38][39].…”

“…Despite evidenced that patients' continued interest in IMS and high levels of Internet medical services utilization (IMSU) maintained after the COVID-19 pandemic, equitable access remains concerns [16][17][18][19][20]. There are concerns that IMS might exacerbate disparities among patients who have limited access to the necessary facilities or lack the skills needed to IMSU.…”

Individual-Level Digital Determinants of Health and Technology Acceptance of Patient Portals: Cross-Sectional Assessment

“…Digital determinants of health (DDoH), including access to technological tools, digital health literacy, and internet access, function independently as barriers to health, and a lack of these aspects negatively impacts health outcomes and patient experiences [ 6 , 7 ]. Data from the COVID-19 and Chronic Conditions cohort analyzing portal use suggested that the restrictive phase of the epidemic widened disparities in health literacy [ 8 ]. Analysis of the Health Information National Trends Survey demonstrated that minority populations had less access to an electronic health record compared to White and non-Hispanic populations [ 9 ].…”

“…In an assessment of patients admitted to a general medicine service, low eHealth literacy was associated with less awareness, use, and perceived usefulness of portals [ 10 ]; however, further investigation of the role of eHealth literacy and DDoH in a nationwide, multilanguage survey is needed. Assessment of enablers and barriers across health care–seeking populations may serve to address extant digital health disparities and mitigate disparity expansion that may occur with public health emergencies [ 11 ]. To enhance patient engagement with digital health technologies and solutions, assessment of individual factors of DDoH, including digital health literacy, has been purported to be the first step to enabling access to these digitized forms of health care [ 12 ].…”