scholarly journals Using the Computer-based Health Evaluation System (CHES) to support self-management of symptoms and functional health: Evaluation of hematological patients’ usage of a web-based patient portal (Preprint)

2020 ◽  
Author(s):  
Jens Lehmann ◽  
Petra Buhl ◽  
Johannes M Giesinger ◽  
Lisa M Wintner ◽  
Monika Sztankay ◽  
...  
Keyword(s):  
Evaluation System ◽  
Functional Health ◽  
Self Management ◽  
Health Evaluation ◽  
Patient Portal ◽  
Structured Interviews ◽  
Patient Portals ◽  
Web Based ◽  
Patient Reported ◽  
Hospital Visits

BACKGROUND Patient portals offer the possibility to assess patient-reported outcome measures (PROMs) remotely and first evidence has demonstrated their potential benefits. OBJECTIVE In this study, we evaluated patients’ use of a web-based patient portal where patients can complete PROMs. The portal was developed to supplement routine monitoring at the Department of Internal Medicine V in Innsbruck. METHODS We included patients with cancer who were already participating in the monitoring at the hospital for usage of the patient portal. Patients were introduced to the portal and asked to complete questionnaires prior to their next hospital visits. We used system access logs and three consecutive semi-structured interviews to analyze patients’ usage and evaluation of the portal. RESULTS Between July 2017 and August 2020, we approached N=122 patients for participation in the study, of whom n=102 (83.6%) consented to use the patient portal. Patients were on average 60 (SD 10.4) years old. Of n=71 patients providing data at all study time points, n=26 (36.6%) patients consistently used the portal prior to their hospital visits. During an average session, patients viewed 5.3 different pages and spent 9.4 minutes logged on to the portal. Feedback from interviews was largely positive with no patients reporting difficulties navigating the survey and 50% of patients valuing the self-management tools provided in the portal. CONCLUSIONS Our study demonstrates how a patient portal can complement a routine PROM implementation at the hospital by reducing the burden of administration for the clinical team and offering an additional way for patients to engage with PROMs.

Young, Empowered and Strong: A Web-Based Education and Supportive Care Intervention for Young Women With Breast Cancer Across the Care Continuum

2021 ◽  
pp. 933-943
Author(s):  
Tal Sella ◽  
Craig Snow ◽  
Hannah Freeman ◽  
Philip D. Poorvu ◽  
Shoshana M. Rosenberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Young Women ◽  
Breast Cancer Survivors ◽  
Metastatic Breast ◽  
Patient Reported Outcome ◽  
Self Management ◽  
Semistructured Interview ◽  
Web Based ◽  
Care Continuum ◽  
Patient Reported

PURPOSE Patient-centered digital interventions may help empower young women to self-manage symptoms and psychosocial concerns and support informational needs often unaddressed in clinic. METHODS Young, Empowered and Strong (YES) is an interactive web-based intervention designed to engage young women with personalized education and symptom self-management resources on the basis of responses to patient-reported outcome–based questionnaires. We piloted YES among young women (< 45 years) with newly diagnosed early breast cancer (EBC) or metastatic breast cancer (MBC) and breast cancer survivors (BCSs). Assessments were deployed weekly (EBC and MBC) or every 4 weeks (BCSs) over 12 weeks. At study completion, use, feasibility, and acceptability of YES were evaluated via a survey and semistructured interview. RESULTS Thirty women were enrolled between April and June 2019: 10 EBC, 10 BCSs, and 10 MBC. The mean age at diagnosis and enrollment was 36 (range 25-44) and 39 (range 31-44) years, respectively. Most participants were actively treated (96%, 27 of 28) with endocrine therapy (54%, 15 of 28) or chemotherapy (43%, 12 of 28). Overall, 61% (180 of 296) of assessments were completed (EBC: 70%, BCSs: 63%, and MBC: 52%). Of 37 patient-reported outcome and need domains, the most frequently triggered were sexual health (EBC: 90%, BCSs: 90%, and MBC: 90%), anxiety (EBC: 80%, BCSs: 90%, and MBC: 90%), stress and mindfulness (EBC: 80%, BCSs: 90%, and MBC: 90%), and fatigue (EBC: 90%, BCSs: 80%, and MBC: 90%). On postpilot survey, participants reported that YES helped them to learn (50%, 7 of 14), monitor (43%, 6 of 14), and manage (57%, 8 of 14) their symptoms. CONCLUSION YES is a feasible and acceptable digital intervention to support young women across the breast cancer care continuum. The nearly universal triggering of sexual and mental health needs suggests suboptimal management in the clinical setting and the potential for self-management through a digital platform.

scholarly journals Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial

10.2196/19685 ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. e19685
Author(s):  
Afaf Girgis ◽  
Ivana Durcinoska ◽  
Anthony Arnold ◽  
Joseph Descallar ◽  
Nasreen Kaadan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Reported Outcomes ◽  
Well Being ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Self Management ◽  
Diverse Population ◽  
Web Based ◽  
Patients With Cancer ◽  
Patient Reported

Background Despite the acceptability and efficacy of e–patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. Objective This pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a diverse population of patients with cancer. Methods Adult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. Results From April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33% (P=.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39%), tiredness (38.4%), worry (32.9%), general wellbeing (32.9%), and sleep (24.1%), aligning with the most frequently accessed self-management domain pages of physical well-being (36%) and emotional well-being (23%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82%), largely in response to the automated clinical alerts (n=877). Conclusions Algorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a diverse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records; (2) the instrumental role nurses play in managing alerts; and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12616000615482; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 International Registered Report Identifier (IRRID) RR2-10.1186/s12885-018-4729-3

scholarly journals Prostate Cancer Survivors’ and Caregivers’ Experiences Using Behavior Change Techniques during a Web-Based Self-Management and Physical Activity Program: A Qualitative Study

2020 ◽  
Vol 9 (10) ◽  
pp. 3244
Author(s):  
Laura Hallward ◽  
Keryn Chemtob ◽  
Sylvie D. Lambert ◽  
Lindsay R. Duncan
Keyword(s):  
Physical Activity ◽  
Prostate Cancer ◽  
Qualitative Study ◽  
Behavior Change ◽  
Management Program ◽  
Self Management ◽  
Positive Outcomes ◽  
Structured Interviews ◽  
Behavior Change Techniques ◽  
Web Based

Both men with prostate cancer and their caregivers report experiencing a number of challenges and health consequences, and require programs to help support the cancer patient–caregiver dyad. A tailored, web-based, psychosocial and physical activity self-management program (TEMPO), which implements behavior change techniques to help facilitate behavior change for the dyads was created and its acceptability was tested in a qualitative study. The purpose of this secondary analysis was to explore the dyads’ experiences using behavior change techniques to change behavior and address current needs and challenges while enrolled in TEMPO. Multiple semi-structured interviews were conducted with 19 prostate cancer-caregiver dyads over the course of the program, resulting in 46 transcripts that were analyzed using an inductive thematic analysis. Results revealed four main themes: (1) learning new behavior change techniques, (2) engaging with behavior change techniques learned in the past, (3) resisting full engagement with behavior change techniques, and (4) experiencing positive outcomes from using behavior change techniques. The dyads’ discussions of encountering behavior change techniques provided unique insight into the process of learning and implementing behavior change techniques through a web-based self-management program, and the positive outcomes that resulted from behavior changes.

Development of self-management tip sheets for medical oncology and surgical patients electronically reporting symptoms in the home-care recovery setting.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 299-299
Author(s):  
Deborah Schrag ◽  
Raymond U. Osarogiagbon ◽  
Sandra L. Wong ◽  
Hannah Hazard ◽  
Jessica J Bian ◽  
...  
Keyword(s):  
Home Care ◽  
Health Systems ◽  
Symptom Management ◽  
Medical Oncology ◽  
Medical Center ◽  
Care Team ◽  
Surgical Patients ◽  
Self Management ◽  
Patient Portal ◽  
Patient Reported

299 Background: Patients receiving cancer treatments, including chemotherapy and surgery, often face immense morbidities. Poor symptom control frequently leads to decreased quality of life and an increased need for acute care services. For patients undergoing chemo, adverse side effects can deter them from receiving life-saving therapies. Similarly, poorly managed postoperative symptoms can delay recovery and timely receipt of adjuvant therapies. Empowering patients to proactively monitor, electronically report, and effectively treat symptoms in the home-care setting is critical to improving clinical outcomes. Methods: Through the NCI’s Moonshot-funded IMPACT consortium, 6 health systems developed a library of 70 open source symptom management tip sheets for medical oncology and surgical patients. The study team went through an iterative process with medical oncologists, surgeons, practice nurses, health educators, and patient advocates. Careful attention was paid to minimize the usage of regional dialects or idioms to ensure scalability and acceptability. The tip sheets achieved passing scores on two validated healthy literacy and readability tools. Results: Tip sheets were accessible to patients participating in the novel eSyM (electronic symptom management) program, a fully EHR-integrated ePRO model.eSyM and the incorporated tips were deployed at four health systems between fall 2019 and spring 2020 (Baptist Cancer Center, West Virginia University, Dartmouth-Hitchcock Medical Center, and Maine Medical Center). Patients enrolled in eSyM had access to the tip sheet library through their patient portal and could view them at any time. In addition, after completing an ePRO questionnaire, patients were given dedicated links to the tips for symptoms they reported. Each developed tip sheet included 4 sections: 1) things you can do on your own, 2) with over-the-counter medications, 3) with the help of your care team, 4) when to call your care team for help. This simplified structure allowed patients to determine how to manage symptoms on their own and when to seek out assistance. Conclusions: Presenting self-management tip sheets in response to patient-reported symptoms through a fully integrated patient portal platform is a novel approach to symptom management. Future efforts will include deploying the library and platform at two additional health institutions and evaluating the adoption, acceptability, and utilization of the tip sheets and their impact on clinical care outcomes.

scholarly journals P356 A comparison of innovative strategies to promote engagement with an IBD patient portal

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S376-S377
Author(s):  
S Carlson ◽  
S McCartney ◽  
P Harrow
Keyword(s):  
Patient Satisfaction ◽  
Patient Engagement ◽  
High Intensity ◽  
Intervention Group ◽  
Patient Portal ◽  
Healthcare Outcomes ◽  
Patient Portals ◽  
Quality Of Data ◽  
Low Intensity ◽  
Patient Reported

Abstract Background Patient portals are available on most major electronic health record (EHR) platforms and present many opportunities to improve patient engagement with services, the quality of data captured and therefore healthcare outcomes and patient satisfaction. Our centre looks after 5100 patients with IBD. We recently adopted the EPIC Systems patient portal MyChart which allows patients to view results, letters and complete patient reported outcomes (PRO). At baseline, few patients were registered for this platform. Our aim was to compare patient engagement with MyChart using a low and higher cost approach and to evaluate patient satisfaction with the platform. Methods 160 consecutive patients were invited to join MyChart between September and October 2020. The low-intensity intervention group were invited to join MyChart via a standardised email without further communication. Newly registered patients and active patients were sent a portal message with disease-specific PRO questionnaire 7 days prior to clinic (HBI, SCCAI and IBD Control). Patients in the high-intensity intervention group received a telephone reminder to encourage completion at each step, which took on average 2 minutes, in addition to email. Engagement with the platform was measured prospectively. After clinic a patient-experience questionnaire was sent to all patients who signed up to the platform. Results 72 patients were included in the low intensity group and 88 in the high intensity group. At baseline only 33% patients were already signed up to MyChart. Significantly more patients newly registered with the patient portal following the high intensity intervention compared to the low (75% vs. 30%, p &lt;0.0001). Overall, patients in the high intensity group were significantly more likely to complete the PRO compared to the low (53% vs. 28%, p=0.002). Patients already registered were 5 times more likely to complete the PRO in the high intensity group compared to low (p=0.017). Platform engagement was not significantly impacted by gender or ethnicity. There was a trend toward lower engagement in patients over 65. 63 patients provided feedback. 87% found MyChart easy to use and 94% said they would complete the PRO questionnaires again. Conclusion In our patient cohort, a higher intensity strategy significantly increased patient registration and engagement with a new patient portal at a minimal cost of time and resource. Healthcare providers can facilitate patient engagement with patient portals and overcome barriers to adoption to unlock transformative opportunities for better quality IBD care, disease monitoring and population-based research.

scholarly journals Web-based self-management support prototype My Kidneys My Health for adults with chronic kidney disease: Co-design and usability testing (Preprint)

2020 ◽  
Author(s):  
Maoliosa Donald ◽  
Heather Beanlands ◽  
Sharon Straus ◽  
Michelle Smekal ◽  
Sarah Gil ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Focus Groups ◽  
Usability Testing ◽  
Video Production ◽  
Self Management ◽  
Management Support ◽  
Web Based ◽  
Support Tool ◽  
Patient Reported

BACKGROUND Supporting patients to self-manage their chronic kidney disease (CKD) has been identified as a research priority by patients with CKD and those that care for them. Self-management has been shown to slow CKD progression and improve the quality of life for individuals living with the disease. Previous work has identified a need for a person-centered, theory-informed web-based tool for CKD self-management that can be individualized to a patient’s unique situation, priorities, and preferences. We addressed this gap using an Integrated Knowledge Translation method and patient engagement principles. OBJECTIVE The aim of this study was to implement the systematic co-design and usability testing of a web-based self-management prototype for adults with CKD (non-dialysis, non-transplant) and their caregivers to enhance self-management support. METHODS A multi-step, iterative system development cycle was used to co-design and test My Kidneys My Health prototype. The 3-step process included: (1) creating website features and content using two sequential focus groups with patients with CKD and caregivers; (2) heuristic testing using Nielsen’s 10 heuristic principles; (3) usability testing through in-person 60-minute interviews with patients with CKD and a caregiver. Patients with CKD, caregivers, clinicians, researchers, software developers, graphic designers, and policy makers were involved in all steps of this study. RESULTS In step 1, 18 participants (14 patients and 4 caregivers) attended one of the two sequential focus groups. The participants provided specific suggestions for simplifying navigation, as well as suggestions to incorporate video, text, audio, interactive components, and visuals to convey information. Five reviewers completed the heuristic analysis (step 2), identifying items mainly related to navigation and functionality. Five participants completed usability testing (step 3) and provided feedback on video production, navigation, features and functionality, and branding. Participants reported visiting the website repeatedly for the following features: personalized food tool, my health care provider question list, symptom guidance based on CKD severity, and medication advice. Usability was high, with a mean System Usability Score of 90 out of 100. CONCLUSIONS My Kidneys My Health prototype is a systematically developed, multi-faceted CKD self-management web-based support tool guided by theory and preferences of patients with CKD and their caregivers. The website is user-friendly and provides features that improve the user experience by tailoring the content and resources to their needs. A feasibility study will provide insight into the acceptability of and engagement with the prototype, and identify preliminary patient reported outcomes (e.g., self-efficacy), as well as potential factors related to implementation. This work is relevant given the shift to virtual care during a pandemic era, providing patients with support when in-person care is restricted. CLINICALTRIAL

scholarly journals Evaluation of a Web-Based Self-Management Program for Patients With Cardiovascular Disease: Explorative Randomized Controlled Trial

10.2196/17422 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e17422
Author(s):  
Marscha M Engelen ◽  
Sandra van Dulmen ◽  
Saskia Puijk-Hekman ◽  
Hester Vermeulen ◽  
Maria WG Nijhuis-van der Sanden ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Intervention Group ◽  
Patient Reported Outcome ◽  
Management Program ◽  
Self Management ◽  
Web Based ◽  
Outcome Measurements ◽  
Patient Reported ◽  
Potential Benefits ◽  
Insight Into

Background Web-based self-management programs have the potential to support patients with cardiovascular disease (CVD) in their self-management (eg, by focusing on behavior change and improving physical activity). The intervention mapping framework was used to develop a web-based program called Vascular View. The Vascular View program contained 6 modules (coping with CVD, setting boundaries, lifestyle, healthy nutrition, being physically active, interaction with health professionals) aiming to increase self-management behavior by tailoring to the perceived problems and (support) needs of patients after CVD. Objective The aim was to test the effectiveness of Vascular View before embarking on a full-scale randomized clinical trial (RCT) by evaluating the potential effectiveness and effect sizes of the Vascular View program and identifying outcome measures most likely to capture the potential benefits. Methods An explorative RCT was performed. Both control and intervention groups received care as usual and, in addition, the intervention group received 12 months of access to a web-based self-management program. Assessment occurred at baseline, 6 months, and 12 months. Outcome measures included general patient-reported outcome measurements: Illness Perception Questionnaire (IPQ), Rand-36, Patient Activation Measure, and patient self-efficacy. Module-specific patient-reported outcome measurements were Beliefs about Medicines Questionnaire, International Physical Activity Questionnaire, Dutch Healthy Diet Index, Fagerström Test for Nicotine Dependence (FTND), Alcohol Use Disorders Identification Test, and Perceived Efficacy in Patient-Physician Interaction. Linear mixed models for repeated measures using intention-to-treat and per-protocol analysis were applied to study differences between the patients in the intervention and control groups. Floor and ceiling effects were explored to give insight into the outcome measures most likely to capture the potential benefits. Results A total of 105 patients in the control group and 103 patients in the intervention group participated in the study. A positive direction of change between baseline and 12 months was shown for most outcome measurements in favor of the intervention group, of which 2 out of 10 outcomes showed a significant effect: attribution of cause of the disease to risk factors and immunity factors (IPQ) and dependency of nicotine (FTND). Floor and ceiling effects were seen in the IPQ, Rand-36, and the self-efficacy questionnaire. Conclusions No conclusion for the efficacy of the Vascular View program or selection of outcome measurements can be taken yet. A process evaluation will be conducted to gain thorough insight into the working elements of the program, patient needs in eHealth, and the use of the program by patients. This can determine for whom web-based self-management programs will work and help to adapt the program. Trial Registration Dutch Trial Register NTR5412; https://www.trialregister.nl/trial/5303 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.6352

scholarly journals Racial, Ethnic, and Socioeconomic Disparities in Web-Based Patient Portal Usage Among Kidney and Liver Transplant Recipients: Cross-Sectional Study (Preprint)

2018 ◽  
Author(s):  
Joel Wedd ◽  
Mohua Basu ◽  
Laura M Curtis ◽  
Kayla Smith ◽  
Denise J Lo ◽  
...  
Keyword(s):  
Higher Education ◽  
Liver Transplant ◽  
Kidney Transplant ◽  
Socioeconomic Disparities ◽  
Patient Portal ◽  
Transplant Recipients ◽  
Patient Portals ◽  
Web Based ◽  
Liver Transplant Recipients ◽  
Racial Ethnic

BACKGROUND Kidney and liver transplant recipients must manage a complex care regimen after kidney transplant. Although the use of Web-based patient portals is known to improve patient-provider communication and health outcomes in chronic disease populations by helping patients manage posttransplant care, disparities in access to and use of portals have been reported. Little is known about portal usage and disparities among kidney and liver transplant recipients. OBJECTIVE The aim of this study was to examine patient racial/ethnic, socioeconomic, and clinical characteristics associated with portal usage among kidney and liver transplant recipients. METHODS The study included all adult kidney and liver transplant recipients (n=710) at a large academic transplant center in the Southeastern United States between March 2014 and November 2016. Electronic medical record data were linked with Cerner portal usage data. Patient portal use was defined as any portal activity (vs no activity) recorded in the Cerner Web-based portal, including viewing of health records, lab results, medication lists, and the use of secure messaging. Multivariable log-binomial regression was used to determine the patient demographic, clinical, and socioeconomic characteristics associated with portal usage, stratified by organ. RESULTS Among 710 transplant recipients (n=455 kidney, n=255 liver), 55.4% (252/455) of kidney recipients and 48.2% (123/255) of liver recipients used the patient portal. Black patients were less likely to use the portal versus white patients among both kidney (57% black vs 74% white) and liver (28% black vs 55% white) transplant recipients. In adjusted multivariable analyses, kidney transplant recipients were more likely to use the portal if they had higher education; among liver recipients, patients who were white versus black and had higher education were more likely to use the portal. CONCLUSIONS Despite studies showing that patient portals have the potential to benefit transplant recipients as a tool for health management, racial and socioeconomic disparities should be considered before widespread implementation. Transplant centers should include portal training and support to all patients to encourage use, given its potential to improve outcomes.

scholarly journals Predictors of Online Patient Portal Use among a Diverse Sample of Emerging Adults: A Cross-Sectional Survey (Preprint)

2021 ◽  
Author(s):  
Julie A. Wright ◽  
Julie E Volkman ◽  
Suzanne G Leveille ◽  
Daniel J. Amante
Keyword(s):  
Health Literacy ◽  
Emerging Adults ◽  
Patient Engagement ◽  
Self Management ◽  
Healthcare Team ◽  
Patient Portal ◽  
Patient Portals ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample

BACKGROUND Self-management of health is becoming increasingly more influenced by Health IT as online patient portals become more common. Patient portals allow patients direct access to their health information and opportunities to engage with their healthcare team. Data suggest that e-Health literacy is an important skill for using portals. Emerging adults (EA; ages 18-29), while generally healthy, are regular users of the healthcare system. A good understanding about their use of online patient portals and how their e-Health literacy skills impact their use is lacking. OBJECTIVE To describe patient portal use and explore the predictors of portal use among a diverse sample of EAs. METHODS A convenience sample, cross-sectional survey study was conducted at two universities. Demographics, healthcare visits, e-Health literacy, patient engagement and use of patient portal features (administrative and clinical) were asked. Logistic regression models were used to examine factors associated with portal use. RESULTS Of the 340 EAs (76% female, 65% white, 47% low income), 54% reported having patient portal access. Of those reporting access, 77% used at least 1 portal feature and 23% reported using none. Significant predictors were patient engagement (OR 1.08, 95% CI 1.04-1.13, p=.001;) and total encounters (OR 1.23, 95% CI 1.05-1.44, p=.009;) but not e-Health literacy. Hispanic and Asian EAs were more likely to be frequent users of clinical portal features than white EAs (Hispanic, OR 2.97, 95%CI 1.03-8.52 p=.043; and Asian, OR 4.28, 95%CI 1.08-16.89, p=.038). CONCLUSIONS Surprisingly, e-Health literacy did not predict use of patient portals in this diverse sample of EAs. Moreover, there may be ethnic differences that are important for healthcare systems to consider. Interventions to promote patient portal use, an essential self-management skill, should include strategies to increase patient engagement with patient portals in EA populations. CLINICALTRIAL N/A

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