The Digital Divide and Patient Portals

Internet Access Explained Differences in Patient Portal Use for Secure Messaging by Age, Race, and Income

Ilana Yonas, Nancy Gordon, Vick Fung, Courtnee Hamity, Mary E. Reed

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: Online access to health records and the ability to exchange secure messages with physicians can improve patient engagement and outcomes; however, the digital divide could limit access to web-based portals among disadvantaged groups. Objectives: To understand whether sociodemographic differences in patient portal use for secure messaging can be explained by differences in internet access and care preferences. Research Design: Cross-sectional survey to examine the association between patient sociodemographic characteristics and internet access and care preferences; then, the association between sociodemographic characteristics and secure message use with and without adjusting for internet access and care preference. Subjects: One thousand forty-one patients with chronic conditions in a large integrated health care delivery system (76% response rate). Measures: Internet access, portal use for secure messaging, preference for in-person or online care, and sociodemographic and health characteristics. Results: Internet access and preference mediated some of the differences in secure message use by age, race, and income. For example, using own computer to access the internet explained 52% of the association between race and secure message use and 60% of the association between income and use (Sobel-Goodman mediation test, P < 0.001 for both). Education and sex-related differences in portal use remained statistically significant when controlling for internet access and preference. Conclusions: As the availability and use of patient portals increase, it is important to understand which patients have limited access and the barriers they may face. Improving internet access and making portals available across multiple platforms, including mobile, may reduce some disparities in secure message use.

Original languageEnglish (US)
Pages (from-to)772-779
Number of pages8
JournalMedical Care
Volume54
Issue number8
DOIs
StatePublished - Aug 1 2016

Fingerprint

Internet
Integrated Delivery of Health Care
Patient Participation
Patient Portals
Digital Divide
Vulnerable Populations
Sex Characteristics
Research Design
Cross-Sectional Studies
Delivery of Health Care
Physicians
Education
Health

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

Cite this

The Digital Divide and Patient Portals : Internet Access Explained Differences in Patient Portal Use for Secure Messaging by Age, Race, and Income. / Yonas, Ilana; Gordon, Nancy; Fung, Vick; Hamity, Courtnee; Reed, Mary E.

In: Medical Care, Vol. 54, No. 8, 01.08.2016, p. 772-779.

Research output: Contribution to journalArticle

@article{7802d05024054841844268d7ade2aa62,
title = "The Digital Divide and Patient Portals: Internet Access Explained Differences in Patient Portal Use for Secure Messaging by Age, Race, and Income",
abstract = "Background: Online access to health records and the ability to exchange secure messages with physicians can improve patient engagement and outcomes; however, the digital divide could limit access to web-based portals among disadvantaged groups. Objectives: To understand whether sociodemographic differences in patient portal use for secure messaging can be explained by differences in internet access and care preferences. Research Design: Cross-sectional survey to examine the association between patient sociodemographic characteristics and internet access and care preferences; then, the association between sociodemographic characteristics and secure message use with and without adjusting for internet access and care preference. Subjects: One thousand forty-one patients with chronic conditions in a large integrated health care delivery system (76{\%} response rate). Measures: Internet access, portal use for secure messaging, preference for in-person or online care, and sociodemographic and health characteristics. Results: Internet access and preference mediated some of the differences in secure message use by age, race, and income. For example, using own computer to access the internet explained 52{\%} of the association between race and secure message use and 60{\%} of the association between income and use (Sobel-Goodman mediation test, P < 0.001 for both). Education and sex-related differences in portal use remained statistically significant when controlling for internet access and preference. Conclusions: As the availability and use of patient portals increase, it is important to understand which patients have limited access and the barriers they may face. Improving internet access and making portals available across multiple platforms, including mobile, may reduce some disparities in secure message use.",
author = "Ilana Yonas and Nancy Gordon and Vick Fung and Courtnee Hamity and Reed, {Mary E.}",
year = "2016",
month = "8",
day = "1",
doi = "10.1097/MLR.0000000000000560",
language = "English (US)",
volume = "54",
pages = "772--779",
journal = "Medical Care",
issn = "0025-7079",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - The Digital Divide and Patient Portals

T2 - Internet Access Explained Differences in Patient Portal Use for Secure Messaging by Age, Race, and Income

AU - Yonas, Ilana

AU - Gordon, Nancy

AU - Fung, Vick

AU - Hamity, Courtnee

AU - Reed, Mary E.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background: Online access to health records and the ability to exchange secure messages with physicians can improve patient engagement and outcomes; however, the digital divide could limit access to web-based portals among disadvantaged groups. Objectives: To understand whether sociodemographic differences in patient portal use for secure messaging can be explained by differences in internet access and care preferences. Research Design: Cross-sectional survey to examine the association between patient sociodemographic characteristics and internet access and care preferences; then, the association between sociodemographic characteristics and secure message use with and without adjusting for internet access and care preference. Subjects: One thousand forty-one patients with chronic conditions in a large integrated health care delivery system (76% response rate). Measures: Internet access, portal use for secure messaging, preference for in-person or online care, and sociodemographic and health characteristics. Results: Internet access and preference mediated some of the differences in secure message use by age, race, and income. For example, using own computer to access the internet explained 52% of the association between race and secure message use and 60% of the association between income and use (Sobel-Goodman mediation test, P < 0.001 for both). Education and sex-related differences in portal use remained statistically significant when controlling for internet access and preference. Conclusions: As the availability and use of patient portals increase, it is important to understand which patients have limited access and the barriers they may face. Improving internet access and making portals available across multiple platforms, including mobile, may reduce some disparities in secure message use.

AB - Background: Online access to health records and the ability to exchange secure messages with physicians can improve patient engagement and outcomes; however, the digital divide could limit access to web-based portals among disadvantaged groups. Objectives: To understand whether sociodemographic differences in patient portal use for secure messaging can be explained by differences in internet access and care preferences. Research Design: Cross-sectional survey to examine the association between patient sociodemographic characteristics and internet access and care preferences; then, the association between sociodemographic characteristics and secure message use with and without adjusting for internet access and care preference. Subjects: One thousand forty-one patients with chronic conditions in a large integrated health care delivery system (76% response rate). Measures: Internet access, portal use for secure messaging, preference for in-person or online care, and sociodemographic and health characteristics. Results: Internet access and preference mediated some of the differences in secure message use by age, race, and income. For example, using own computer to access the internet explained 52% of the association between race and secure message use and 60% of the association between income and use (Sobel-Goodman mediation test, P < 0.001 for both). Education and sex-related differences in portal use remained statistically significant when controlling for internet access and preference. Conclusions: As the availability and use of patient portals increase, it is important to understand which patients have limited access and the barriers they may face. Improving internet access and making portals available across multiple platforms, including mobile, may reduce some disparities in secure message use.

UR - http://www.scopus.com/inward/record.url?scp=84975144641&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84975144641&partnerID=8YFLogxK

U2 - 10.1097/MLR.0000000000000560

DO - 10.1097/MLR.0000000000000560

M3 - Article

VL - 54

SP - 772

EP - 779

JO - Medical Care

JF - Medical Care

SN - 0025-7079

IS - 8

ER -