Patient Portals as a Tool for Health Care Engagement: A Mixed-Method Study of Older Adults With Varying Levels of Health Literacy and Prior Patient Portal Use

Health literacy has been described as the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Improving health literacy may serve to promote concordance with therapy, engage patients in their own health care, and improve health outcomes. Patient portal technology aims at enabling patients and families to have easy access to key information in their own medical records and to communicate with their health care providers electronically. However, there is a gap in our understanding of how portals will improve patient outcome. The authors believe patient portal technology presents an opportunity to improve patient concordance with prescribed therapy, if adequate support is provided to equip patients (and family/carers) with the knowledge needed to utilise the health information available via the portals. Research is needed to understand what a health consumer will use patient portals for and how to support a user to realise the technology?s potential.

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Disparities in registration and use of an online patient portal among older adults: findings from the LitCog cohort

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocv025 ◽

2015 ◽

Vol 22 (4) ◽

pp. 888-895 ◽

Cited By ~ 82

Author(s):

Samuel G Smith ◽

Rachel O’Conor ◽

William Aitken ◽

Laura M Curtis ◽

Michael S Wolf ◽

...

Keyword(s):

Older Adults ◽

Health Literacy ◽

College Graduates ◽

Vital Statistics ◽

Patient Portal ◽

Test Results ◽

Patient Portals ◽

Adequate Health Literacy ◽

Checking Test ◽

White Patients

Abstract Objective To document disparities in registration and use of an online patient portal among older adults. Materials and methods Data from 534 older adults were linked with information from the Northwestern Medicine Electronic Data Warehouse on patient portal registration and use of functions (secure messaging, prescription reauthorizations, checking test results, and monitoring vital statistics). Age, gender, race, education, self-reported chronic conditions, and the Newest Vital Sign health literacy measure were available from cohort data. Results Most patients (93.4%) had a patient portal access code generated for them, and among these 57.5% registered their accounts. In multivariable analyses, White patients (P < .001) and college graduates were more likely to have registered their patient portal (P = .015). Patients with marginal (P = .034) or adequate (P < .001) health literacy were also more likely to have registered their patient portal. Among those registering their accounts, most had messaged their physician (90%), checked a test result (96%), and ordered a reauthorization (55%), but few monitored their vital statistics (11%). Adequate health literacy patients were more likely to have used the messaging function (P = .003) and White patients were more likely to have accessed test results (P = .004). Higher education was consistently associated with prescription reauthorization requests (all P < .05). Discussion Among older American adults, there are stark health literacy, educational, and racial disparities in the registration, and subsequent use of an online patient portal. These population sub-group differences may exacerbate existing health disparities. Conclusions If patient portals are implemented, intervention strategies are needed to monitor and reduce disparities in their use.

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Novel Interventions and Assessments Using Patient Portals in Adolescent Research: Confidential Survey Study (Preprint)

10.2196/preprints.8340 ◽

2017 ◽

Author(s):

Lindsay A Thompson ◽

Rebeccah Mercado ◽

Thomas Martinko ◽

Ratna Acharya

Keyword(s):

Health Care ◽

Health Literacy ◽

Intervention Group ◽

Office Visit ◽

Survey Study ◽

Control Group ◽

Patient Portal ◽

Parental Consent ◽

Patient Portals ◽

Communication Preferences

BACKGROUND While adolescents can receive confidential health care without parental or guardian notification, they are rarely asked about their experiences and opinions regarding their care because participation in research often requires parental consent. Anonymous research with adolescents via confidential patient portals may ameliorate this research gap. OBJECTIVE Because use of a confidential online adolescent patient portal is high at our academic institution, we hypothesized that adolescents would also respond to survey-based research via the portal, especially if asked anonymously and without parental consent. We used a clinical scenario of needing to better understanding adolescent and young adults’ views about their health and health care, including information on a long-acting reversible contraceptive (LARC) to test if and how they will use a portal for research. METHODS Upon receiving Institutional Review Board approval, we sent 2 portal-based surveys about confidential services to 2 groups of females, ages 14 to 25 years, who had attended an adolescent clinic in the past 3 years. This clinic mostly serves Medicaid recipients (80%) and is racially and ethnically diverse with half of patients identifying as African American and roughly 10% Hispanic. The control group was a random sample of female patients who never received a LARC (n=150) and the intervention group included all female adolescents who had received a LARC from the same clinic (n=107). This second sample was manually cross-checked to confirm they had an office visit for this reason. Consenting for themselves, the control group received an email through the patient portal with a link and a request to perform an assessment. The survey for the control group included items assessing health literacy and health communication preferences. The survey for the intervention group included health literacy items as well as items to assess their opinions and perceptions regarding LARCs. We tracked click-through rates and opened messages; each participant received 4 reminders. RESULTS While only 3 participants fully completed either survey, email read rates (29/107 [27.1%] of LARC recipients and 39/150 [26.0%] of controls) were encouraging. Additionally, of those who opened the messages, almost twice as many of the LARC recipients (10/107 [9.3%]) read through the entire survey, while less than half read the entire survey as compared to those who received the survey asking about health literacy and health care preferences (6/150 [4.0%]). CONCLUSIONS The methodology of using adolescent portals for online surveys provides a new avenue for research even though the study did not yield sufficient participation to understand these adolescents’ preferences. Future studies need to test if a different survey topic would engage adolescents or if other methods like text-based reminders would improve participation.

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Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study (Preprint)

10.2196/preprints.5322 ◽

2015 ◽

Author(s):

Juhee Kim ◽

Holly Mathews ◽

Lindsay M Cortright ◽

Xiaoming Zeng ◽

Edward Newton

Keyword(s):

Health Care ◽

Mixed Methods ◽

Health Literacy ◽

Pregnant Women ◽

Low Income ◽

Patient Portal ◽

Care Providers ◽

Patient Portals ◽

Convenience Sample ◽

Prenatal Health

BACKGROUND Patient portals offer patients personalized and secure Web access to their medical information and enable patients to manage their health care online. However, there is a lack of information about patient acceptance and use of patient portals among low-income pregnant women. OBJECTIVE This formative research aims to assess the potential of a patient portal, MyChart, for improving prenatal health care and pregnancy outcomes, and identify the barriers and facilitators of MyChart use among low-income pregnant women. METHODS A mixed-methods study was conducted with a convenience sample of 18 low-income pregnant women comprising low- and high-risk patients enrolled in a prenatal clinic in eastern North Carolina. MyChart use, patient demographics, and pregnancy information were collected by reviewing electronic medical charts. Health literacy was measured. Reported use and attitudes toward MyChart were collected using a semi-structured interview. RESULTS Although 39% (7/18) of participants interviewed signed up for MyChart, only 22% (4/18) of them became active users. Another 33% (6/18) had never heard of MyChart or was unsure of how to access it. Users primarily accessed test results and appointment schedules. The main facilitating factors for patient portal use were information and motivation from health care providers and concerns about pregnancy due to a history of miscarriage. Reported barriers were lack of educational resources, lack of care provider encouragement, and technical difficulties possibly exacerbated by low health literacy. Participants also suggested improvements for MyChart, especially the provision of discussion-based support for pregnant women. CONCLUSIONS The one-time verbal introduction of MyChart does not meet current patients’ needs. Data reveal the need for more consistent patient education and support programs, tailored to patients’ previous pregnancy histories. The clinic also needs to facilitate better provider-patient communication about the importance of MyChart use.

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Older Adults' Perceptions and Use of Patient Portals: A Comparative Analysis of Two Samples

Innovation in Aging ◽

10.1093/geroni/igab046.3039 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 837-837

Author(s):

Hyojin Son ◽

Eun-Shim Nahm ◽

Shijun Zhu ◽

Elizabeth Galik ◽

Barbara Van de Castle ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Older Adult ◽

Health Care System ◽

Self Efficacy ◽

Community Sample ◽

Patient Portal ◽

Patient Portals ◽

Perceived Usability ◽

Care System

Abstract Older adults can benefit from using patient portals. Little is known whether the perceptions and use of patient portals differ among diverse older adult populations. The aim of this study was to assess the difference in perceived usability of patient portals, self-efficacy for using patient portals, and patient portal use between two adult samples aged 65 years or older. One sample was recruited from a health care system, including hospitals and clinics (n = 174), and the other sample was recruited from nationwide communities (n = 126). Conducting a secondary data analysis using two survey datasets, this study performed a series of linear and ordinal logistic regression analyses. The health care system sample had a higher mean number of chronic diseases and proportion of recent hospitalization than the community sample. The health care system sample showed higher perceived usability, self-efficacy, and usage frequency of patient portals compared to the community sample. eHealth literacy was a significant predictor of perceived usability and self-efficacy. Perceived usability was another significant predictor of self-efficacy. Self-efficacy and health condition variables significantly predicted the more frequent use of patient portals. Compared to the health care system sample, the relationship between perceived usability and use of patient portals was stronger and significant in the community sample. These findings suggest that approaches for promoting patient portal use should consider personal characteristics and health conditions of diverse older adult populations. Future research needs to focus on assessing the impact of using patient portals on older adults’ health care outcomes.

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Developing Physical Activity Promotion Plans for Older Adults Who Live Alone with Low-income Based on Socio-ecological Model: A Mixed Method Study

Korean Journal of Sport Studies ◽

10.23949/kjpe.2019.03.58.2.15 ◽

2019 ◽

Vol 58 (02) ◽

pp. 15-34 ◽

Cited By ~ 1

Author(s):

Kyung-O Kim

Keyword(s):

Physical Activity ◽

Older Adults ◽

Low Income ◽

Mixed Method ◽

Ecological Model ◽

Physical Activity Promotion ◽

Mixed Method Study ◽

Activity Promotion

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Older Adults’ Engagement in Technology‐Mediated Self‐Monitoring of Diet: A Mixed‐Method Study

Journal of Nursing Scholarship ◽

10.1111/jnu.12619 ◽

2020 ◽

Vol 53 (1) ◽

pp. 25-34

Author(s):

Caroline Farsjø Aure ◽

Anders Kluge ◽

Anne Moen

Keyword(s):

Older Adults ◽

Mixed Method ◽

Mixed Method Study ◽

Self Monitoring

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Limited English Proficiency and Disparities in Health Care Engagement Among Patients With Breast Cancer

JCO Oncology Practice ◽

10.1200/op.20.01093 ◽

2021 ◽

pp. OP.20.01093

Author(s):

Mohana Roy ◽

Natasha Purington ◽

Mina Liu ◽

Douglas W. Blayney ◽

Allison W. Kurian ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

Clinical Trial ◽

Genetic Counseling ◽

English Proficiency ◽

Primary Language ◽

Patient Portal ◽

Language Groups ◽

English Speaking ◽

Health Care Engagement

PURPOSE: Race and ethnicity have been shown to affect quality of cancer care, and patients with low English proficiency (LEP) have increased risk for serious adverse events. We sought to assess the impact of primary language on health care engagement as indicated by clinical trial screening and engagement, use of genetic counseling, and communication via an electronic patient portal. METHODS: Clinical and demographic data on patients with breast cancer diagnosed and treated from 2013 to 2018 within the Stanford University Health Care system were compiled via linkage of electronic health records, an internal clinical trial database, and the California Cancer Registry. Logistic and linear regression models were used to evaluate for association of clinical trial engagement and patient portal message rates with primary language group. RESULTS: Patients with LEP had significantly lower rates of clinical trial engagement compared with their English-speaking counterparts (adjusted odds ratio [OR], 0.29; 95% CI, 0.16 to 0.51). Use of genetic counseling was similar between language groups. Rates of patient portal messaging did not differ between English-speaking and LEP groups on multivariable analysis; however, patients with LEP were less likely to have a portal account (adjusted OR, 0.89; 95% CI, 0.83 to 0.96). Among LEP subgroups, Spanish speakers were significantly less likely to engage with the patient portal compared with English speakers (estimated difference in monthly rate: OR, 0.43; 95% CI, 0.24 to 0.77). CONCLUSION: We found that patients with LEP had lower rates of clinical trial engagement and odds of electronic patient portal enrollment. Interventions designed to overcome language and cultural barriers are essential to optimize the experience of patients with LEP.

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