Patient Portal Utilization Among Ethnically Diverse Low Income Older Adults: Observational Study

Arcury, Thomas A.; Quandt, Sara A.; Sandberg, Joanne C.; Miller, David P.; Latulipe, Celine; Leng, Xiaoyan; Talton, Jenifer W; Melius, Kathryn; Smith, Alden; Bertoni, Alain G.

doi:10.2196/medinform.8026

Cited by 61 publications

(136 citation statements)

References 54 publications

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“…This research fits within a larger longitudinal research project investigating older adult patients and caregiver usage of electronic patient portals [ 2 , 36 ]. In that project, a set of patients and caregivers have been interviewed periodically over a period of 2 years to understand the patient portal adoption and usage.…”

Section: Methodsmentioning

confidence: 99%

Insights Into Older Adult Patient Concerns Around the Caregiver Proxy Portal Use: Qualitative Interview Study

Latulipe¹,

Quandt²,

Melius³

et al. 2018

J Med Internet Res

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BackgroundElectronic patient portals have become common and offer many potential benefits for patients’ self-management of health care. These benefits could be especially important for older adult patients dealing with significant chronic illness, many of whom have caregivers, such as a spouse, adult child, or other family member or friend, who help with health care management. Patient portals commonly contain large amounts of personal information, including diagnoses, health histories, medications, specialist appointments, lab results, and billing and insurance information. Some health care systems provide proxy accounts for caregivers to access a portal on behalf of a patient. It is not well known how much and in what way caregivers are using patient portals on behalf of patients and whether patients see any information disclosure risks associated with such access.ObjectiveThe objective of this study was to examine how older adult patients perceive the benefits and risks of proxy patient portal access by their caregivers.MethodsWe conducted semistructured interviews with 10 older adult patients with chronic illness. We asked them about their relationship with their caregivers, their use of their patient portal, their caregiver’s use of the portal, and their perceptions about the benefits and risks of their caregiver’s use of the portals. We also asked them about their comfort level with caregivers having access to information about a hypothetical diagnosis of a stigmatized condition. Two investigators conducted a thematic analysis of the qualitative data.ResultsAll patients identified caregivers. Some had given caregivers access to their portals, in all cases by sharing log-in credentials, rather than by setting up an official proxy account. Patients generally saw benefits in their caregivers having access to the information and functions provided by the portal. Patients generally reported that they would be uncomfortable with caregivers learning of stigmatized conditions and also with caregivers (except spouses) accessing financial billing information.ConclusionsPatients share their electronic patient portal credentials with caregivers to receive the benefits of those caregivers having access to important medical information but are unaware of all the information those caregivers can access. Better portal design could alleviate these unwanted information disclosures.

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Section: Methodsmentioning

confidence: 99%

Insights Into Older Adult Patient Concerns Around the Caregiver Proxy Portal Use: Qualitative Interview Study

Latulipe¹,

Quandt²,

Melius³

et al. 2018

J Med Internet Res

Self Cite

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“…Training, engaging caregivers, and increasing access to technology in public settings have all been identified as potential avenues for improving access and use of patient portals. 32 Engaging in these strategies with a patient will require a comprehensive assessment of their social and emotional well-being as well as their acceptance of the technology. Documentation of these conversations will be critical so that all members of the care team are able to engage in care planning for the patient as this relationship becomes more dependent on technology.…”

Section: Discussionmentioning

confidence: 99%

Electronic Health Record Documentation Patterns of Recorded Primary Care Visits Focused on Complex Communication: A Qualitative Study

et al. 2019

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Background In a time-constrained clinical environment, physicians cannot feasibly document all aspects of an office visit in the electronic health record (EHR). This is especially true for patients with multiple chronic conditions requiring complex clinical reasoning. It is unclear how physicians prioritize the documentation of health information in the EHR. Objective The goal of this study is to examine documentation tradeoffs made by physicians when caring for complex patients by comparing the content of office visit conversations with resulting EHR documentation. Methods We used grounded theory method of qualitative analysis to assess emergent themes in the transcripts of 10 office visits, and then compared the themes to documentation in the EHR. Differences between discussion and subsequent documentation of social and emotional health topics and each of the other key categories were compared using the Wilcoxon signed-rank test. Results The categories that emerged included “chronic conditions,” “acute/new problems,” “disease prevention,” and “social and emotional health.” We found that when social and emotional topics were discussed in the office visit, it was documented in the medical record only 30.6% of the time. Chronic conditions, acute/new problems, and disease prevention were documented in the EHR between 87.5 and 91.7% of the time after discussion. The differences between discussion and documentation of social and emotional topics were significantly greater than the differences for chronic conditions, acute/new problems, and disease prevention (all p < 0.05). Conclusion Social and emotional factors, while extremely relevant to health management, are less likely than medical concerns to be documented after discussion in an office visit. This lack of documentation may hinder interdisciplinary communication between teams informing individualized therapeutic decisions during acute care handoffs, such as outpatient to inpatient care.

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“…Among this highly educated but lower income sample, there was a high but not universal level of access to the Internet as well as weekly use of the Internet, which has been previously demonstrated. 20 In addition, this study explored assessed Internet gateway modality with past portal use and anticipated future use, which highlights obstacles to overcome as well as strategies for future portal engagement.…”

Section: Discussionmentioning

confidence: 99%

Internet Access Influences Community Clinic Portal Use

et al. 2018

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Purpose: To assess whether individuals attending a community clinic had the necessary Internet access and experience to use the patient portal, while examining covariates of education, income, and self-perception of health with past and anticipated portal use.Methods: Adults attending an urban, community primary care clinic were invited to participate in a brief survey assessing current Internet access and use, past portal use, and anticipated future portal use. Survey responses were analyzed using descriptive and multivariate statistics.Results: One hundred fifteen participants ranging in age from 18 to 84 years (mean 42.1, standard deviation 17.1) completed the survey; 6 (5%) in Spanish. Thirty-five (30%) self-identified as Latino; 12 (10%) as Asian; and 20 (17%) as other. Almost 80% reported their health as good or better. Although 38% reported some college and 47% reported being college graduates, 60% reported household incomes were <$50,000. Most (87%) used the Internet for >1 year. Fewer than half (42%) had past portal use, with significant differences associated with weekly Internet use (Fisher's exact=9.59; p=0.02) and smart phone access (Fisher's exact=6.15; p=0.02). Computer Internet access was significantly associated with income (Fisher's exact=16.91; p<0.001). Logistic regression identified that computer Internet access was a significant predictor (odds ratio 9.9 (95% confidence interval: 1.7–58.8) of future portal use, controlling for smart phone use, health status, gender, and age.Conclusions: Among this highly educated but lower economic sample, computer Internet access and smart phone access were associated with past portal use and anticipated future use.

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Patient Portal Utilization Among Ethnically Diverse Low Income Older Adults: Observational Study

Cited by 61 publications

References 54 publications

Insights Into Older Adult Patient Concerns Around the Caregiver Proxy Portal Use: Qualitative Interview Study

Insights Into Older Adult Patient Concerns Around the Caregiver Proxy Portal Use: Qualitative Interview Study

Electronic Health Record Documentation Patterns of Recorded Primary Care Visits Focused on Complex Communication: A Qualitative Study

Internet Access Influences Community Clinic Portal Use

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