Study: 'Stark' disparities in portal registration, use

There are substantial differences in the acceptance and use of online patient portals by different consumer groups, which may exacerbate health disparities among them and have a downstream impact on care, according to a study published in the Journal of the American Medical Informatics Association (JAMIA).

Online portals have been touted as a tool to improve patient engagement and health outcomes. However, they won't work if they're not being used.

A study of 534 older adults with online patient portal access in the Chicago area found that while almost all of the patients had the access code to register for the portal, only 57.5 percent actually registered. Moreover, there were "stark" disparities regarding who was signing up, the study says. Men, whites and those with fewer chronic conditions were more likely to register, as were those who were highly educated or health-literate. For instance, 71.7 percent of registrants were white; 65.3 percent were male.  

There were fewer demographic disparities when it came to using the portal. However, those differences could have significant impact from a clinical standpoint. For instance, 92.7 percent of the "adequate" health literacy group members had sent a message to their physician via the portal compared to 61.1 percent of those with "limited" literacy, which could indicate more follow up and other care to those in the literate group.

Other studies have noted challenges in enticing patients to use portals and other methods of patient engagement. It has been suggested that portal design and functionality as well as lack of knowledge of their existence may also be barriers to portal adoption and use.

White patients were more than 10 times more likely to check their test results than black patients; highly educated patients were more likely to refill prescriptions, indicating better medication adherence.

The researchers recommended that "[h]ealthcare systems adopting online technologies such as patient portals should continuously monitor Internet connectivity rates within their population to avoid exacerbating disparities." They also recommended that further research focus on barriers to registration to reduce the "digital divide" and to look at other factors, such as usability of the portals or smartphones as portals.

To learn more:
- read the study