Exploring Early Adopter Baby Boomers' Approach to Managing Their Health and Healthcare

The Patient 3.0 Profile is used to explore to the patient engagement strategies of early adopter baby boomers' in three domains: 1) patient relationships, 2) health information use and 3) consumer health technology (CHT) use. Findings from six focus groups with early adopter boomers challenge prior notions about older adults' passive approach to patient engagement. Baby boomers want to make final healthcare decisions with input from providers. While adept at finding and critically assessing online health information for self-education and self-management, boomers want providers to curate relevant and trustworthy information. Boomers embrace CHTs offered through providers (i.e., patient portals, email and text messaging) and sponsored by wellness programs (i.e., diet and activity devices and apps). However, there is no indication they add information to their online medical records or use CHT for diagnosis, treatment or disease management. Additional resources are needed to encourage widespread adoption, support patient effectiveness, and confirm cost-benefit.

The Digitisation of Healthcare in a Global Pandemic

The chapter discusses the rapid digitisation of healthcare during the COVID-19 global crisis and its implications for healthcare quality from patient, clinician, and provider perspectives. Using the example of patient portals, online interfaces that provide patients with real-time access to their health records, the chapter explores how this large-scale shift to digital healthcare has influenced key elements of healthcare quality. These elements include the safety, timeliness, effectiveness, efficiency, equity, eco-friendliness, and person-centeredness of care delivery, as well as patient and staff well-being. The discussion addresses health anxiety exacerbated by remote service delivery and potential associations with cyberchondria and online search behaviours. Additionally, concerns about digital health literacy, equality of access, patient data privacy, and cybersecurity are discussed in the context of increasing health system shocks. Recommendations are made about how the future adaptation of digital healthcare can support healthcare quality in a post-pandemic era.

Exploring the Value of Using Patient-Oriented MRI Reports in Clinical Practice

Purpose Standard radiology reports (SRR) are designed to communicate information between doctors. With many patients having instantaneous access to SRRs on patient portals, interpretation without guidance from doctors can cause anxiety and panic. We designed a patient-centred prostate MRI template report (PACERR) to address some of these challenges and tested whether PACERRs improve patient knowledge and experience. Materials and Methods Patients booked for clinical prostate MRI were randomly assigned to SRR or SRR + PACERR. Questionnaires included multiple-choice that targeted 4 domains (understanding, usefulness, next steps, emotional experience) hypothesized to improve with patient-centred reports and short answer questions, testing knowledge regarding MRI results. Clinical encounters were observed and recorded to explore whether adding PACERR improved communication. Likert scaled-responses and short-answer questions were compared using Mann-Whitney U test and Kruskal-Wallis test. Results Of the 40 participants, the majority were MRI naïve (70%). Patients receiving a PACERR had higher scores in the categories of patient understanding (mean: 4.17 vs. 3.39, p=0.006), usefulness (mean: 4.58 vs. 3.07, p<0.001), and identifying next steps (mean: 1.89 vs. 3.03, p=0.003) but not emotional experience (mean: 4.18 vs. 3.79, p=0.22). PACERR participants found the layout and design more patient friendly (mean: 4.47 vs. 2.61, p<0.001) and easier to understand (mean: 4.37 vs. 2.38, p<0.001). In the knowledge section, overall, the PACERR arm scored better (87% vs. 56%, p=0.004). Conclusion With the addition of Prostate MRI PACERR, participants had better understanding of their results and felt more prepared to involve themselves in discussions with their doctor.

Educating Clinicians to Improve Telemedicine Access for Patients with Limited English Proficiency

The COVID-19 pandemic prompted the rapid incorporation of telemedicine into healthcare systems, resulting in increased access challenges for patients in the United States with limited English proficiency (LEP). Non-English-language speakers face challenges with telemedicine that magnify pre-existing barriers to language-appropriate care, such as difficulty accessing professional medical interpreters and navigating both electronic health information and online patient portals. Improved medical education on telehealth would increase equitable care for linguistic minorities. Medical education targeting telehealth care delivery should include clinician instruction on working with interpreters in telehealth contexts, increasing patient access to telehealth resources, and addressing patients’ language needs for telemedicine.

Maximizing Opportunities for User-Centered Design in Acute-Care: Introducing the Focal Wall

Digital health is a promising development in the pursuit of patient centered care. Technological developments, like patient portals, are providing new opportunities for patients to engage in their own healthcare journeys, increasing access to health data and practitioners in many cases. The primary objective of this research is the establishment of an in-patient portal for a new children’s hospital through a collaborative design process. This paper details experiences from the first phase of this multi-year project and in particular methodological solutions that have been developed in order to meet the challenges of engaging acute care patients, families, and practitioners in user-centered design within such a demanding context.

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

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.

Association between Patient Portal Usage and Perceived Patient-Centered Communication among Adults with Cancer: Cross-Sectional Survey Study (Preprint)

BACKGROUND Patient-centered communication (PCC) plays a vital role in effective cancer management and care. Patient portals are increasingly available to patients and hold potential as a valuable tool to facilitate PCC. However, whether the use of patient portals may improve perceived PCC or which mechanisms might mediate this relationship has not been studied. OBJECTIVE The primary goal of this study was to investigate the association between the frequency of access to patient portals and perceived PCC in patients with cancer. A secondary goal was to explore whether this association was mediated by patients' self-efficacy in health information seeking. METHODS We used data from the Health Information National Trend Survey 5 (HINTS 5) cycle 3 (2019) and cycle 4 (2020). The present analysis includes 1,222 individuals who self-reported having a current or past diagnosis of cancer. Perceived PCC was measured with a 7-item HINTS derived scale and classified as low, medium, or high. Patient portal usage was measured by a single item assessing the frequency of use. Self-efficacy about health information seeking was assessed with a one-item measure assessing confidence in obtaining health information. We used adjusted multinomial logistic regression models to estimate relative risk ratios (RRR) of the association between patients' patient portal usage and perceived PCC. Mediation by health information self-efficacy was investigated using the Baron and Kenny and Karlson, Holm, and Breen methods. RESULTS 54.5% of the sample reported that they did not access their patient portals in the past 12 months, 12.6 % accessed it 1-2 times, 24.8% accessed it 3-9 times, and 8.2% accessed it 10 or more times. Overall, the frequency of accessing the patient portal was marginally associated (P=0.06) with perceived PCC in an adjusted multinominal logistic regression model. Patients who accessed their patient portal 10 or more times in the previous 12 months were almost 4 times more likely (RRR=3.8; 95% CI 1.6–9.0) to report high perceived PCC. In mediation analysis, the association between patient portal use and perceived PCC was attenuated adjusting for health information seeking self-efficacy, but those with the most frequent patient portal use (ten or more times in the previous 12 months) were still almost 2.5 times more likely to report high perceived PCC (RRR=2.4; 95% CI 1.1–5.6) compared to those with no portal use. CONCLUSIONS PCC is an integral part of patient-centered care. Those who reported the greatest use of patient portals were more likely to report higher perceived PCC. These findings emphasize the importance of encouraging cancer patients and providers to use patient portals to increase patient-centeredness of care and suggest that interventions to promote the adoption and use of patient portals could incorporate strategies to improve health information self-efficacy.