Is research on patient portals attuned to health equity? A scoping review

Abstract Objective Our scoping review examined how research on patient portals addresses health equity. Questions guiding our review were: 1) What health equity concepts are addressed in patient portal research—both explicitly and implicitly? 2) What are the gaps? 3) Is the potential for ehealth-related health inequities explicitly acknowledged in studies on patient portals? 4) What novel approaches and interventions to reduce health inequities are tested in patient portal research? Materials and Methods We searched 4 databases. Search terms included “patient portal” in combination with a comprehensive list of health equity terms relevant in ehealth context. Authors independently reviewed the papers during initial screening and full-text review. We applied the eHealth Equity Framework to develop search terms and analyze the included studies. Results Based on eHealth Equity Framework categories, the main findings generated from 65 reviewed papers were governance structures, ehealth policies, and cultural and societal values may further inequities; social position of providers and patients introduces differential preferences in portal use; equitable portal implementation can be supported through diverse user-centered design; and intermediary strategies are typically recommended to encourage portal use across populations. Discussion The predominant focus on barriers in portal use may be inadvertently placing individual responsibility in addressing these barriers on patients already experiencing the greatest health disparities. This approach may mask the impact of the socio-technical-economic-political context on outcomes for different populations. Conclusion To support equitable health outcomes related to patient portals we need to look beyond intermediary initiatives and develop equitable strategies across policy, practice, research, and implementation.

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

Journal of Medical Internet Research ◽

10.2196/14410 ◽

2020 ◽

Vol 22 (2) ◽

pp. e14410 ◽

Cited By ~ 6

Author(s):

Xiang Zhong ◽

Jaeyoung Park ◽

Muxuan Liang ◽

Fangyun Shi ◽

Pamela R Budd ◽

...

Keyword(s):

Primary Care ◽

Service Utilization ◽

Care Delivery ◽

Care Service ◽

Primary Care Service ◽

Patient Portal ◽

Patient Portals ◽

Appointment Adherence ◽

Primary Care Patients ◽

The Impact

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.

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Chinese Americans’ use of patient portal systems: a scoping review (Preprint)

10.2196/preprints.27924 ◽

2021 ◽

Author(s):

Katharine Lawrence ◽

Stella Chong ◽

Holly Krelle ◽

Timothy Roberts ◽

Lorna Thorpe ◽

...

Keyword(s):

Scoping Review ◽

Chinese American ◽

Chinese Americans ◽

Barriers And Facilitators ◽

Future Research ◽

Sample Population ◽

Patient Portal ◽

Patient Portals ◽

Cross Sectional ◽

Use Patterns

BACKGROUND Patient portals are increasingly deployed in healthcare systems as communication and information-sharing tools for patients and providers. While portals show promise in addressing healthcare access, quality, and outcomes, research on portal access and use patterns among diverse populations is limited, including among Chinese Americans. OBJECTIVE This study aimed to summarize existing evidence on the access and use patterns, barriers, and facilitators of patient portals among Chinese Americans, and to identify gaps and areas for future research. METHODS The authors conducted a scoping review using the PRISMA Protocol for Scoping Reviews of articles published in major databases (MEDLINE, Embase, PsycINFO) on the topic of patient portals and Chinese Americans. Authors independently reviewed the papers during initial screening and full-text review. The studies were analyzed and coded for study method type, sample population, and main outcomes of interest. RESULTS In total 17 articles were selected for inclusion in the review. The included articles varied in study aims, methodology, data collection, sample population, and geographic areas of study. The majority of studies were cross-sectional in nature. Major findings and themes identified from the articles include: variable patterns of patient portal access and use among Chinese Americans compared to other racial/ethnic groups; limited evidence on the specific barriers and facilitators of access and use for this group; a reliance on quantitative proxy measures (e.g. log-ins, click-throughs) to assess portal access and use; and a pattern of aggregating Chinese American-related data into a larger Asian or Asian American designation. CONCLUSIONS There is limited research dedicated to understanding the use patterns, experiences, and needs of Chinese Americans who access and utilize patient portal systems. Most research is cross-sectional, focusing on disparities in use and access, and have tended to aggregate the Chinese American experience into that of Asian Americans. Future research should focus specifically on Chinese Americans and prioritize more detailed evaluations of their relationship to patient portal technology to understand specific use patterns, preferences, and needs. A broader understanding of the diversity of health technology users can help ensure applicable and equitable design, development, and implementation of these tools. CLINICALTRIAL N/a

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Patient Portal Implementation and Uptake: Qualitative Comparative Case Study

Journal of Medical Internet Research ◽

10.2196/18973 ◽

2020 ◽

Vol 22 (7) ◽

pp. e18973 ◽

Cited By ~ 1

Author(s):

Melita Avdagovska ◽

Mark Ballermann ◽

Karin Olson ◽

Timothy Graham ◽

Devidas Menon ◽

...

Keyword(s):

Health Care Providers ◽

Current Status ◽

Comparative Case Study ◽

Patient Portal ◽

Care Providers ◽

Patient Portals ◽

National Goal ◽

Patient Centered ◽

The Impact

Background Giving patients access to their health information is a provincial and national goal, and it is critical to the delivery of patient-centered care. With this shift, patient portals have become more prevalent. In Alberta, the Alberta Health Services piloted a portal (MyChart). There was a need to identify factors that promoted the use of this portal. Furthermore, it was imperative to understand why there was variability in uptake within the various clinics that participated in the pilot. Objective This study aims to identify potential factors that could improve the uptake of MyChart from the perspectives of both users and nonusers at pilot sites. We focused on factors that promoted the use of MyChart along with related benefits and barriers to its use, with the intention that this information could be incorporated into the plan for its province-wide implementation. Methods A qualitative comparative case study was conducted to determine the feasibility, acceptability, and initial perceptions of users and to identify ways to increase uptake. Semistructured interviews were conducted with 56 participants (27 patients, 21 providers, 4 nonmedical staff, and 4 clinic managers) from 5 clinics. Patients were asked about the impact of MyChart on their health and health care. Providers were asked about the impact on the patient-provider relationship and workflow. Managers were asked about barriers to implementation. The interviews were recorded, transcribed verbatim, and entered into NVivo. A thematic analysis was used to analyze the data. Results Results from a comparison of factors related to uptake of MyChart in 5 clinics (2 clinics with high uptake, 1 with moderate uptake, 1 with low uptake, and 1 with no uptake) are reported. Some theoretical constructs in our study, such as intention to use, perceived value, similarity (novelty) of the technology, and patient health needs, were similar to findings published by other research teams. We also identified some new factors associated with uptake, including satisfaction or dissatisfaction with the current status quo, performance expectancy, facilitating conditions, behavioral intentions, and use behavior. All these factors had an impact on the level of uptake in each setting and created different opportunities for end users. Conclusions There is limited research on factors that influence the uptake of patient portals. We identified some factors that were consistent with those reported by others but also several new factors that were associated with the update of MyChart, a new patient portal, in the clinics we studied. On the basis of our results, we posit that a shared understanding of the technology among patients, clinicians, and managers, along with dissatisfaction with nonportal-based communications, is foundational and must be addressed for patient portals to support improvements in care.

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Characteristics of Patients Using Different Patient Portal Functions and the Impact on Primary Care Service Utilization and Appointment Adherence (Preprint)

10.2196/preprints.14410 ◽

2019 ◽

Author(s):

Xiang Zhong ◽

Jaeyoung Park ◽

Muxuan Liang ◽

Fangyun Shi ◽

Pamela R. Budd ◽

...

Keyword(s):

Primary Care ◽

Service Utilization ◽

Care Service ◽

Office Visit ◽

Health Problems ◽

Primary Care Service ◽

Patient Portal ◽

Patient Portals ◽

Appointment Adherence ◽

The Impact

BACKGROUND Patient portals are now widely available and increasingly adopted by patients and providers. OBJECTIVE The objective of this study was to investigate the characteristics of primary care patients using different patient portal functions and the impact of patient portal usage on patients’ primary care service utilization and appointment adherence. METHODS A retrospective observational study using a large dataset of primary care patients of University of Florida (UF) Health was conducted. A total of 4312 patient portal users and 17580 nonusers were identified during the study period July 2013 – June 2016. Patients were classified into different user subgroups based on their portal usage of messaging, laboratory, appointment, and medication functions. The association between patient demographics and portal usage were analyzed. Primary care service utilization and appointment adherence were measured by primary care office visits arrived, no-show, cancellation, and telephone encounter rates per quarter. Generalized linear models (GLM) were built to compare the time-dependent portal usage effects across different user subgroups and nonusers. RESULTS Five different user subgroups based on their dominant portal activities and usage frequency were identified. After adopting portals, patients with fewer active health problems used portal infrequently (silent users). Medicare (P = 0.04), White, and age 46-64 (P = 0.01) and 65 and older (P = 0.04) were positively associated with messaging usage. Age 19-30 (P < 0.001) was positively associated with appointment usage, and gender female (P = 0.01) was positively associated with laboratory usage. On the impact of portal usage, disease burden adjusted rate ratios (RR) between user subgroups and nonusers were obtained. The office visit and telephone encounter RRs of users to nonusers were significantly larger than 1 right after portal adoption (with P values less than 0.05), but were not significantly different 2 years after adoption, except for the silent users, whose office visit and telephone encounter rates were significantly smaller after around 1 year post portal adoption (with P values less than 0.05). Office visit cancellation rates were not changed, and no-show rates were significantly reduced or at least not changed post portal adoption. Patients who used messaging and laboratory functions more often exhibited a larger reduction in no-show among other user subgroups. CONCLUSIONS Interestingly, a high propensity to adopt patient portals does not necessarily imply more frequent usage of portals. In particular, the number of active health problems was negatively associated with portal adoption but was positively associated with portal usage. For patients with fewer active health problems, their primary care service utilization was even lower after portal adoption; with a heavy disease burden, the utilization was temporarily increased but was not significantly changed after 2 years post adoption. Overall, appointment adherence was improved after portal adoption.

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Health Equity in Artificial Intelligence and Primary Care Research: Protocol for a Scoping Review (Preprint)

10.2196/preprints.27799 ◽

2021 ◽

Author(s):

Jonathan Xin Wang ◽

Sulaiman Somani ◽

Jonathan H Chen ◽

Sara Murray ◽

Urmimala Sarkar

Keyword(s):

Artificial Intelligence ◽

Primary Care ◽

Health Equity ◽

Scoping Review ◽

Underserved Populations ◽

Care Delivery ◽

Data Extraction ◽

Cochrane Library ◽

Preventative Care ◽

The Impact

BACKGROUND Though artificial intelligence (AI) has potential to augment the patient-physician relationship in primary care, bias in intelligent healthcare systems has the potential to differentially impact vulnerable patient populations. OBJECTIVE The purpose of this scoping review is to summarize the extent to which AI systems in primary care examine the inherent bias towards or against vulnerable populations and appraise how these systems have mitigated the impact of such biases during their development. METHODS We will conduct a search update from an existing scoping review to identify AI and primary care articles in the following databases: Medline-OVID,Embase,CINAHL, Cochrane Library, Web of Science, Scopus, IEEE Xplore, ACM Digital Library, MathSciNet, AAAI, and arXiv. Two screeners will independently review all abstracts, titles and full-texts. The team will extract data using structured data extraction form and synthesize the results according to PRISMA-Scr guidelines. RESULTS This review will provide an assessment of the current state of healthcare equity within AI for primary care. Specifically, we will identify the degree to which vulnerable patients have been included, assess how bias is interpreted and documented, and understand the extent harmful biases are addressed. As of October 2020, the scoping review is in the title and abstract screening stage. The results are expected to be submitted for publication in fall of 2021. CONCLUSIONS AI applications in primary care are becoming an increasingly common tool in health care delivery, including in preventative care efforts for underserved populations. This scoping review aims to understand to what extent AI-primary care studies employ a health equity lens and take steps to mitigate bias.

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Ethical, Stigma, and Policy Implications of Food Addiction: A Scoping Review

Nutrients ◽

10.3390/nu11040710 ◽

2019 ◽

Vol 11 (4) ◽

pp. 710 ◽

Cited By ~ 14

Author(s):

Stephanie Cassin ◽

Daniel Buchman ◽

Samantha Leung ◽

Karin Kantarovich ◽

Aceel Hawa ◽

...

Keyword(s):

Scoping Review ◽

Food Addiction ◽

Personal Control ◽

Policy Implications ◽

Individual Responsibility ◽

Differential Impact ◽

Policy Interventions ◽

Will Power ◽

The Impact

The concept of food addiction has generated much controversy. In comparison to research examining the construct of food addiction and its validity, relatively little research has examined the broader implications of food addiction. The purpose of the current scoping review was to examine the potential ethical, stigma, and health policy implications of food addiction. Major themes were identified in the literature, and extensive overlap was identified between several of the themes. Ethics sub-themes related primarily to individual responsibility and included: (i) personal control, will power, and choice; and (ii) blame and weight bias. Stigma sub-themes included: (i) the impact on self-stigma and stigma from others, (ii) the differential impact of substance use disorder versus behavioral addiction on stigma, and (iii) the additive stigma of addiction plus obesity and/or eating disorder. Policy implications were broadly derived from comparisons to the tobacco industry and focused on addictive foods as opposed to food addiction. This scoping review underscored the need for increased awareness of food addiction and the role of the food industry, empirical research to identify specific hyperpalatable food substances, and policy interventions that are not simply extrapolated from tobacco.

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Tackling Health Inequities and Reducing Obesity Prevalence: The EPODE Community-Based Approach

Annals of Nutrition and Metabolism ◽

10.1159/000446223 ◽

2016 ◽

Vol 68 (Suppl. 2) ◽

pp. 35-38 ◽

Cited By ~ 16

Author(s):

Jean-Michel Borys ◽

Pierre Richard ◽

Hugues Ruault du Plessis ◽

Pauline Harper ◽

Emile Levy

Keyword(s):

Health Equity ◽

Vegetable Consumption ◽

Statistical Significance ◽

Health Inequities ◽

Current Data ◽

Rank Test ◽

Obesity Prevalence ◽

Policy Agendas ◽

Education Groups ◽

The Impact

Background: Tackling inequalities in overweight, obesity and related complications has become a top priority for European research and policy agendas. It is well-known that the health message often does not reach disadvantaged populations, a phenomenon that widens health inequalities. Ensemble Prévenons l'Obésité des Enfants (EPODE) methodology is an innovative approach to counteract obesity and improve health equity. EPODE for the Promotion of Health Equity (EPHE) has assessed the impact and sustainability of the EPODE methodology to diminish inequalities in childhood obesity prevention. The current data represent the results of the intermediate measurements that were obtained following EPHE interventions in 7 European communities across different countries. Methods: A total of 1,062 children aged 6-8 years and their parents from different socioeconomic backgrounds were observed for 2 years. A self-administrated questionnaire was sent to parents to measure the children's energy balance-related behaviors and their determinants. The Wilcoxon signed-rank test was used to test differences between baseline and intermediate measurements for each socioeconomic group. Results: We observed changes in behaviors (fruit and vegetable consumption, sugary sweetened beverage consumption, screen exposure) and their related determinants, within the low and high education groups, which were associated with identified inequity gaps at baseline. Although statistical significance was not reached in most of the cases, greater improvements in behaviors were evident within the low education groups. Conclusions: Our findings show that, after EPODE interventions, the low socioeconomic groups improved their behavior compared to the other socio-economic groups. This indicates that the EPODE methodology has the capacity not only to reduce obesity prevalence but also to decrease health inequities.

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The Impact of Artificial Intelligence on Health Equity in Oncology: A Scoping Review

Blood ◽

10.1182/blood-2021-149264 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4934-4934

Author(s):

Paul Istasy ◽

Wen Shen Lee ◽

Alla Iansavitchene ◽

Ross Upshur ◽

Bekim Sadikovic ◽

...

Keyword(s):

Artificial Intelligence ◽

Decision Making ◽

Health Equity ◽

Scoping Review ◽

Clinical Decision Making ◽

Ethical Issues ◽

Clinical Decision ◽

Resource Limited Settings ◽

Resource Limited ◽

The Impact

Abstract Introduction: The expanding use of Artificial Intelligence (AI) in hematology and oncology research and practice creates an urgent need to consider the potential impact of these technologies on health equity at both local and global levels. Fairness and equity are issues of growing concern in AI ethics, raising problems ranging from bias in datasets and algorithms to disparities in access to technology. The impact of AI on health equity in oncology, however, remains underexplored. We conducted a scoping review to characterize, evaluate, and identify gaps in the existing literature on AI applications in oncology and their implications for health equity in cancer care. Methodology: We performed a systematic literature search of MEDLINE (Ovid) and EMBASE from January 1, 2000 to March 28, 2021 using key terms for AI, health equity, and cancer. Our search was restricted to English language abstracts with no restrictions by publication type. Two reviewers screened a total of 9519 abstracts, and 321 met inclusion criteria for full-text review. 247 were included in the final analysis after assessment by three reviewers. Studies were analysed descriptively, by location, type of cancer and AI application, as well as thematically, based on issues pertaining to health equity in oncology. Results: Of the 247 studies included in our analysis, 150 (60.7%) were based in North America, 57 (23.0%) in Asia, 29 (11.7%) in Europe, 5 (2.1%) in Central/South America, 4 (1.6%) in Oceania, and 2 (0.9%) in Africa. 71 (28.6%) were reviews and commentaries, and 176 were (71.3%) clinical studies. 25 (10.1%) focused on AI applications in screening, 42 (17.0%) in diagnostics, 46 (18.6%) in prognostication, and 7 (2.9%) in treatment. 40 (16.3%) used AI as a tool for clinical/epidemiological research and 87 (35.2%) discussed multiple applications of AI. A diverse range of cancers were represented in the studies, including hematologic malignancies. Our scoping review identified three overarching themes in the literature, which largely focused on how AI might improve health equity in oncology. These included: (1) the potential for AI reduce disparities by improving access to health services in resource-limited settings through applications such as low-cost cancer screening technologies and decision support systems; (2) the ability of AI to mitigate bias in clinical decision-making through algorithms that alert clinicians to potential sources of bias thereby allowing for more equitable and individualized care; (3) the use of AI as a research tool to identify disparities in cancer outcomes based on factors such as race, gender and socioeconomic status, and thus inform health policy. While most of the literature emphasized the positive impact of AI in oncology, there was only limited discussion of AI's potential adverse effects on health equity . Despite engaging with the use of AI in resource-limited settings, ethical issues surrounding data extraction and AI trials in low-resource settings were infrequently raised. Similarly, AI's potential to reinforce bias and widen disparities in cancer care was under-examined despite engagement with related topics of bias in clinical decision-making. Conclusion: The overwhelming majority of the literature identified by our scoping review highlights the benefits of AI applications in oncology, including its potential to improve access to care in low-resource settings, mitigate bias in clinical decision-making, and identify disparities in cancer outcomes. However, AI's potential negative impacts on health equity in oncology remain underexplored: ethical issues arising from deploying AI technologies in low-resources settings, and issues of bias in datasets and algorithms were infrequently discussed in articles dealing with related themes. Disclosures No relevant conflicts of interest to declare.

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Are patient portals being used to support palliative and end-of-life care?: A scoping review (Preprint)

10.2196/preprints.28797 ◽

2021 ◽

Author(s):

M. Pilar Ingle ◽

Cristina Valdovinos ◽

Kelsey L. Ford ◽

Shou Zhou ◽

Sheana Bull ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Scoping Review ◽

Future Research ◽

Patient Portal ◽

Patient Portals ◽

User Acceptability ◽

National Coalition ◽

Meta Analyses ◽

Hospice And Palliative Care

BACKGROUND Although patient portals are widely used for health promotion, little is known about use of palliative care and end-of-life (PCEOL) portal tools available for patients and caregivers. OBJECTIVE To identify and assess user perspectives of PCEOL portal tools available to patients and caregivers described and evaluated in the literature. METHODS A scoping review of the academic literature directed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR). We searched three databases. Sources were included if they reported the development or testing of a feature, resource, tool, or intervention, focused on at least one PCEOL domain defined by the National Coalition for Hospice and Palliative Care, targeted adults with serious illness and/or caregivers, and were offered via patient portal tethered to an electronic medical record. Authors independently screened titles and abstracts (N=796) for eligibility. Full texts (N=84) sources were reviewed. Descriptions of the portal tool name, content, targeted population, and reported user acceptability for each tool were abstracted from included sources (N=19). RESULTS Nineteen articles describing 12 tools were included, addressing the following PCEOL domains: ethical/legal (N=5), physical (N=5), and psychological/psychiatric (N=2). No tools for bereavement or hospice were identified. Studies reported high acceptability of tools among users; however, few sources commented on usability among older adults. CONCLUSIONS PCEOL patient portal tools are understudied. As medical care increasingly moves towards virtual platforms, future research should investigate the usability and acceptability of PCEOL patient portals resources and evaluate their impact on health outcomes.

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Patient Portals: Objectives, Acceptance, and Effects on Health Outcome – A Scoping Review of Reviews

10.3233/shti210560 ◽

2021 ◽

Author(s):

I. Leb ◽

S. Magnin ◽

H.-U. Prokosch ◽

M. Boeker

Keyword(s):

Health Outcome ◽

Scoping Review ◽

Health Record ◽

Patient Portal ◽

Patient Portals ◽

Secure Messaging ◽

Scoping Reviews ◽

Prisma Statement ◽

Review Of Reviews ◽

Facilitators And Barriers

Patient portals provide patients access to their electronic health record and other functions as secure messaging. For over a decade, more and more patient portals are developed for various settings. The aim of this scoping review of reviews is to systematically search the literature for existing reviews to provide an overview of patient portals’ objectives, acceptance and effects on outcome. We followed the PRISMA Statement and its extension for scoping reviews, and searched for articles published in 2011–2021. The 19 included articles were considerably heterogeneous concentrating on health outcome or patient portal facilitators and barriers.

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