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

10.2196/14410 ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. e14410 ◽  
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.

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

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.

The Impact of Structured Laboratory Routines in Computerized Medical Records in a Primary Care Service Setting

2005 ◽  
Vol 29 (6) ◽  
pp. 619-626 ◽  
Author(s):  
Daniel A. Vardy ◽  
Tzachit Simon ◽  
Yehuda Limoni ◽  
Oded Kuperman ◽  
Ira Rabzon ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Records ◽  
Care Service ◽  
Primary Care Service ◽  
Service Setting ◽  
Computerized Medical Records ◽  
The Impact

scholarly journals Primary Care Service Utilization Among People at High Risk of Fatal Opioid Overdose: A Short Communication on an Autopsy Study

2020 ◽  
Vol 11 ◽  
pp. 215013272092595
Author(s):  
Matthew Jones ◽  
Ceri Bradshaw ◽  
Jenna Jones ◽  
Ann John ◽  
Helen Snooks ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Service Utilization ◽  
Care Service ◽  
Median Number ◽  
Primary Care Service ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Autopsy Study ◽  
Drug Dependent

Objectives: We sought to explore the sociodemographics and primary care service utilization among people who died from opioid overdose and to assess the possibility of using this information to identify those at high risk of opioid overdose using routine linked data. Methods: Data related to decedents of opioid overdose between January 1, 2012 and December 31, 2015 were linked with general practitioner (GP) records over a period of 36 months prior to death. Results: Of n = 312 decedents of opioid overdose, 73% were male (n = 228). Average age at death was 40.72 (SD 11.92) years. A total of 63.8% of the decedents were living in the 2 most deprived quintiles according to the Welsh Index of Multiple Deprivation. Over 80% (n = 258) of the decedents were recorded as having at least 1 GP episode during the 36-month observation period prior to death. The median number of episodes per decedent was 75 [38-118]. Overall, 31.8% (n = 82) of decedents with at least 1 GP episode received a prescription for a proton pump inhibitor and 31% (n = 80) were prescribed a broad-spectrum antibiotic. According to their GP records, less than 10% were referred to or receiving specialist drug treatment (n = 24, 9.3%); or were known to be drug dependent (n = 21, 8.14%), or a drug user (n = 5, 1.94%). In all, 81% were recorded as smokers (n = 209) and 10.5% as ex-smokers (n = 27). Conclusions: The majority of decedents of opioid overdose were in contact with GP services prior to death. GPs are either often unaware of high-risk opioid use, or rarely record details of opioid use in patient notes. It is possible that GP awareness of high-risk opioid use could be increased. For example, awareness of the risks associated with opioid use, and the relationship between the sociodemographic and clinical characteristics of opioid overdose decedents could be raised using educational materials prominently displayed in waiting areas. Clinicians in primary care may be in an excellent position to intervene in problematic opioid use.

EXPECTATION OF CLIENTS TOWARDS PRIMARY CARE SERVICE AT COMMUNE HEALTH CENTERS

2017 ◽  
pp. 70-77
Author(s):  
Thi Hoa Nguyen ◽  
Thi Thao Nguyen ◽  
Minh Tam Nguyen
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Primary Care Patient ◽  
Care Service ◽  
Care Patient ◽  
Care Quality ◽  
Health Centers ◽  
Primary Care Service ◽  
Cross Sectional ◽  
Care Services

Background: Patients’ expectations are considered to influence their satisfaction with the service provided. This can be used to provide a deeper understanding and better approach to improve health care delivery. Objectives: This study was to identify patients' expectations forhealth care services at commune health centers in Huong Thuy Town, Thua Thien Hue province. Methods: A cross-sectional study with data collected from 423 people in Huong Thuy, using the 38-item standardized questionnaire to measure patients' expectations of primary care. A five score Likert scale from strongly disagree to strongly agree was used to report people’s expectation towards primary care services at commune health centers. Results: Among five important features of primary care, patient expectations for aspects of the medical care were the highest ranking. Aspects that achieved the lowest expectations were the availability and accessibility. The items such as “Facilities should be well equipped and modern”, “Doctor should guide patient in taking medicines correctly” and “Doctor should make patient feel free and comformtable to talk about health issues” received the highest scores. Conclusions: The study provides evidence on what patients expect for primary care service, thus helps to improve primary care quality, especially on the aspects that patients rate highest priorities. Key words: primary care, patient’s expectation, commune health center

scholarly journals Enhanced Primary Care improves GP service regularity in older patients without impacting on service frequency

2012 ◽  
Vol 18 (4) ◽  
pp. 295 ◽  
Author(s):  
David A. J. Gibson ◽  
Rachael E. Moorin ◽  
David Preen ◽  
Jon Emery ◽  
C. D'Arcy J. Holman
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Multinomial Logistic Regression ◽  
Care Service ◽  
Primary Care Service ◽  
Service Utilisation ◽  
Relative Likelihood ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

The objective of this study was to assess the impact of Enhanced Primary Care service utilisation on subsequent GP service regularity and frequency. The study involved a retrospective population-based longitudinal cohort using linked administrative health records of hospital and primary care services for people over the age of 65 years. Multinomial logistic regression modelling was used to evaluate changes in the relative likelihood of increased primary care service regularity and frequency in exposed and unexposed individuals adjusting for age, sex and recent chronic disease hospitalisation history. Enhanced Primary Care services significantly and substantially increased the relative likelihood of increased regularity with no corresponding higher likelihood of increased frequency of GP contact. Increased regularity was more likely with increasing age except for the oldest age group (90+ years). Some chronic disease histories (e.g. diabetes) showed a higher likelihood of improved regularity while others were less likely to produce an increased regularity (e.g. hypertension). The study suggests a capacity for modification of physician and patient behaviour using incentivised services within the current fee-for-service system in Australia.

scholarly journals Do socially complex patients seek primary care from clinics specifically designed to meet their needs?

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Alan Katz ◽  
Dan Chateau ◽  
Carole Taylor ◽  
Jeff Valdivia
Keyword(s):  
Primary Care ◽  
Population Health ◽  
Social Complexity ◽  
Care Service ◽  
Primary Care Service ◽  
Income Quintile ◽  
Care Providers ◽  
Social Data ◽  
Children In Care ◽  
The Impact

ABSTRACTObjectivesTo determine the relationship between known social complexity and model of primary care service deliveryApproachThe impacts of the social determinants of health are well described. To understand the contribution of specific factors on primary care service use we linked social data in the Population Health Research Data Repository at the Manitoba Centre for Health Policy to health system data. We included all patients visiting a Winnipeg clinic at least three times between 2010 and 2013. We allocated each participant to the primary care provider providing the majority of their care; and each provider was assigned to the model of care where they provided the majority of their clinical care. We developed eleven new indicators to describe social complexity such as: children in care, low income quintile, income assistance (welfare), high residential mobility, and involvement with the justice system. Results The cohort included 626,264 unique individuals of whom 53.1% were female. The majority of participants received their care from the fee for service (FFS) model (511,763) followed by 76,261 assigned to “reformed FFS”. 16,536 and 12,178 were assigned to the 2 team-based care alternative funded models and 9,526 to the teaching clinic model. Patients with social complexities, except for newcomers, were more likely to attend the alternative funded clinics. The patients these clinics served were generally very complex with over 15% having more than 5 complexities compared to less than 5% of those attending the FFS models. Twice as many patients in the FFS models (60%) had no complexities compared to the alternative funded models.ConclusionThe availability of social data in population health repositories provides new opportunities to understand the distribution of these social factors amongst care providers and the impact of each on the health of populations. This new understanding can support focused interventions to address specific social risk factors and provide the evidence to support different models of primary care service delivery.

scholarly journals Quit Experiences among Primary Care Patients Enrolled in a Smoking Cessation Pilot RCT Early in the COVID-19 Pandemic

2021 ◽  
Vol 18 (3) ◽  
pp. 1011
Author(s):  
Andrea A. Joyce ◽  
Grace M. Styklunas ◽  
Nancy A. Rigotti ◽  
Jordan M. Neil ◽  
Elyse R. Park ◽  
...  
Keyword(s):  
Primary Care ◽  
Text Messaging ◽  
Risk Perceptions ◽  
Environmental Changes ◽  
Age Groups ◽  
Text Messages ◽  
Increased Risk ◽  
Primary Care Patients ◽  
The Impact ◽  
At Home

The impact of the COVID-19 pandemic on US adults’ smoking and quitting behaviors is unclear. We explored the impact of COVID-19 on smoking behaviors, risk perceptions, and reactions to text messages during a statewide stay-at-home advisory among primary care patients who were trying to quit. From May–June 2020, we interviewed smokers enrolled in a 12-week, pilot cessation trial providing text messaging and mailed nicotine replacement medication (NCT04020718). Twenty-two individuals (82% white, mean age 55 years), representing 88% of trial participants during the stay-at-home advisory, completed exit interviews; four (18%) of them reported abstinence. Interviews were thematically analyzed by two coders. COVID-19-induced environmental changes had mixed effects, facilitating quitting for some and impeding quitting for others. While stress increased for many, those who quit found ways to cope with stress. Generally, participants felt at risk for COVID-19 complications but not at increased risk of becoming infected. Reactions to COVID-19 and quitting behaviors differed across age groups, older participants reported difficulties coping with isolation (e.g., feeling disappointed when a text message came from the study and not a live person). Findings suggest that cessation interventions addressing stress and boredom are needed during COVID-19, while smokers experiencing isolation may benefit from live-person supports.

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