skip to main content

Explore Research Products in the PAR
It may take a few hours for recently added research products to appear in PAR search results.


Title: Disparities in patient portal access by US adults before and during the COVID-19 pandemic
Abstract Objective

Online patient portals become important during disruptions to in-person health care, like when cases of coronavirus disease 2019 (COVID-19) and other respiratory viruses rise, yet underlying structural inequalities associated with race, socio-economic status, and other socio-demographic characteristics may affect their use. We analyzed a population-based survey to identify disparities within the United States in access to online portals during the early period of COVID-19 in 2020.

 Materials and Methods

The National Cancer Institute fielded the 2020 Health and Information National Trends Survey from February to June 2020. We conducted multivariable analysis to identify socio-demographic characteristics of US patients who were offered and accessed online portals, and reasons for nonuse.

 Results

Less than half of insured adult patients reported accessing an online portal in the prior 12 months, and this was less common among patients who are male, are Hispanic, have less than a college degree, have Medicaid insurance, have no regular provider, or have no internet. Reasons for nonuse include: wanting to speak directly to a provider, not having an online record, concerns about privacy, and discomfort with technology.

 Discussion

Despite the rapid expansion of digital health technologies due to COVID-19, we found persistent socio-demographic disparities in access to patient portals. Ensuring that digital health tools are secure, private, and trustworthy would address some patient concerns that are barriers to portal access.

 Conclusion

Expanding the use of online portals requires explicitly addressing fundamental inequities to prevent exacerbating existing disparities, particularly during surges in cases of COVID-19 and other respiratory viruses that tax health care resources.

  more » « less
Award ID(s):
1955805
PAR ID:
10385974
Author(s) / Creator(s):
; ;
Publisher / Repository:
Oxford University Press
Date Published:
Journal Name:
JAMIA Open
Volume:
5
Issue:
4
ISSN:
2574-2531
Format(s):
Medium: X
Sponsoring Org:
National Science Foundation
More Like this
  1. ; ; ; ; ( , MIS quarterly)
    null (Ed.)
    Hospitalization of patients with chronic diseases poses a significant burden on the healthcare system. Frequent hospitalization can be partially attributed to the failure of healthcare providers to engage effectively with their patients. Recently, patient portals have become popular as information technology (IT) platforms that provide patients with online access to their medical records and help them engage effectively with healthcare providers. Despite the popularity of these portals, there is a paucity of research on the impact of patient–provider engagement on patients’ health outcomes. Drawing on the theory of effective use, we examine the association between portal use and the incidence of subsequent patient hospitalizations, based on a unique, longitudinal dataset of patients’ portal use, across a 12-year period at a large academic medical center in North Texas. Our results indicate that portal use is associated with improvements in patient health outcomes along multiple dimensions, including the frequency of hospital and emergency visits, readmission risk, and length of stay. This is one of the first studies to conduct a large-scale, longitudinal analysis of a health IT system and its effect on individual level health outcomes. Our results highlight the need for technologies that can improve patient–provider engagement and improve overall health outcomes for chronic disease management. 
    more » « less
  2. ; ; ; ; ; ; ; ; ; ( , Public Health Reports®)
    Introduction

    Few US studies have examined the usefulness of participatory surveillance during the coronavirus disease 2019 (COVID-19) pandemic for enhancing local health response efforts, particularly in rural settings. We report on the development and implementation of an internet-based COVID-19 participatory surveillance tool in rural Appalachia.

     Methods

    A regional collaboration among public health partners culminated in the design and implementation of the COVID-19 Self-Checker, a local online symptom tracker. The tool collected data on participant demographic characteristics and health history. County residents were then invited to take part in an automated daily electronic follow-up to monitor symptom progression, assess barriers to care and testing, and collect data on COVID-19 test results and symptom resolution.

     Results

    Nearly 6500 county residents visited and 1755 residents completed the COVID-19 Self-Checker from April 30 through June 9, 2020. Of the 579 residents who reported severe or mild COVID-19 symptoms, COVID-19 symptoms were primarily reported among women (n = 408, 70.5%), adults with preexisting health conditions (n = 246, 70.5%), adults aged 18-44 (n = 301, 52.0%), and users who reported not having a health care provider (n = 131, 22.6%). Initial findings showed underrepresentation of some racial/ethnic and non–English-speaking groups.

     Practical Implications

    This low-cost internet-based platform provided a flexible means to collect participatory surveillance data on local changes in COVID-19 symptoms and adapt to guidance. Data from this tool can be used to monitor the efficacy of public health response measures at the local level in rural Appalachia.

     
    more » « less
  3. ; ; ; ; ; ; ( , Journal of the American Medical Informatics Association)
    Abstract Objective Through the coronavirus disease 2019 (COVID-19) pandemic, telemedicine became a necessary entry point into the process of diagnosis, triage and treatment. Racial and ethnic disparities in health care have been well documented in COVID-19 with respect to risk of infection and in-hospital outcomes once admitted, and here we assess disparities in those who access healthcare via telemedicine for COVID-19 . Materials and Methods Electronic health record data of patients at New York University Langone Health between March 19th and April 30, 2020 were used to conduct descriptive and multilevel regression analyses with respect to visit type (telemedicine or in-person), suspected COVID diagnosis and COVID test results. Results Controlling for individual and community-level attributes, Black patients had 0.6 times the adjusted odds (95%CI:0.58-0.63) of accessing care through telemedicine compared to white patients, though they are increasingly accessing telemedicine for urgent care, driven by a younger and female population. COVID diagnoses were significantly more likely for Black versus white telemedicine patients. Discussion There are disparities for Black patients accessing telemedicine, however increased uptake by young, female Black patients. Mean income and decreased mean household size of Zip code were also significantly related to telemedicine use. Conclusion Telemedicine access disparities reflect those in in-person healthcare access. Roots of disparate use are complex and reflect individual, community, and structural factors, including their intersection; many of which are due to systemic racism. Evidence regarding disparities that manifest through telemedicine can be used to inform tool design and systemic efforts to promote digital health equity. 
    more » « less
  4. ; ; ( , IEEE)
    Covid-19 outbreak represents an exceptional test of the flexibility and the efficiency of patient medical records transfer among healthcare providers which ended up in boundless interruption to the healthcare industry. This public crisis has pushed for an urgent innovation of the patient medical records transference (PMRT) system to meet the needs and provide appropriate patient care. Moreover, the drawback effects of Covid-19 changed the healthcare system forever, more patients are requesting more control, secure, and smoother experience when they want access to their health records. However, the problems stem from the lack of interoperability among the healthcare system and providers and the added burden of cyber-attacks on an already stressed system call for an immediate solution. In this work, we present a secured blockchain framework that ensures patients full ownership over their medical data which can be stored in their private IPFS and later can be shared with an authorized provider. The analysis of the proposed security and privacy aspects shows promising results in providing time savings and resulted in enhanced confidentiality and less disruption in patient-provider interactions. 
    more » « less
  5. ; ; ; ( , Allergy, Asthma & Clinical Immunology)
    Abstract Background

    COVID-19 disproportionately affects those with preexisting conditions, but little research has determined whether those with chronic diseases view the pandemic itself differently - and whether there are differences between chronic diseases. We theorized that while individuals with respiratory disease or autoimmune disorders would perceive greater threat from COVID-19 and be more supportive of non-pharmaceutical interventions (NPIs), those with autoimmune disorders would be less likely to support vaccination-based interventions.

     Methods

    We conducted a two-wave online survey conducted in February and November 2021 asking respondents their beliefs about COVID-19 risk perception, adoption and support of interventions, willingness to be vaccinated against COVID-19, and reasons for vaccination. Regression analysis was conducted to assess the relationship of respondents reporting a chronic disease and COVID-19 behaviors and attitudes, compared to healthy respondents adjusting for demographic and political factors.

     Results

    In the initial survey, individuals reporting a chronic disease had both stronger feelings of risk from COVID-19 as well as preferences for NPIs than healthy controls. The only NPI that was still practiced significantly more compared to healthy controls in the resample was limiting trips outside of the home. Support for community-level NPIs was higher among individuals reporting a chronic disease than healthy controls and remained high among those with respiratory diseases in sample 2. Vaccine acceptance produced more divergent results: those reporting chronic respiratory diseases were 6% more willing to be vaccinated than healthy controls, while we found no significant difference between individuals with autoimmune diseases and healthy controls. Respondents with chronic respiratory disease and those with autoimmune diseases were more likely to want to be vaccinated to protect themselves from COVID-19, and those with an autoimmune disease were more likely to report fear of a bad vaccine reaction as the reason for vaccine hesitancy. In the resample, neither those with respiratory diseases nor autoimmune diseases reported being more willing to receive a booster vaccine than healthy controls.

     Conclusions

    It is not enough to recognize the importance of health in determining attitudes: nuanced differences between conditions must also be recognized.

     
    more » « less
  • Citation Formats
  • MLA
  • APA
  • Chicago
  • BibTeX
  • Save / Share this Record
  • Send to Email