Patient Portals Could Exacerbate Disparities Among Older Patients

A study of the use of patient portals among older Americans found clear disparities in the registration and use of this technology. The results were published in the Journal of the Americans Medical Informatics Association.

The researchers analyzed data from 534 older adults, age 55 years and older, who were linked with information from the Northwestern Medicine Electronic Data Warehouse on patient portal registration and use of functions. While 93.4% of patients had a patient portal access code generated for them, only 57.5% registered their accounts.

Overall, white patients (71.7%) were more likely to register compared with African American patients (27.7%), as were college graduates (68.8%) compared with patients with a high school education (29.2%) and patients with adequate health literacy (72.7%) compared with patients with marginal (46.4%) or limited (21.7%) health literacy.

Interestingly, the researchers found that older Americans with no chronic conditions were more likely to have registered than those with chronic conditions.

“Broadly, our findings suggest research should focus on addressing the barriers faced by older underserved populations at the registration stage of patient portal initiation,” the authors wrote. “There is an established ‘digital divide’ in Internet connectivity, and this is likely to be a contributing factor.”

While they recommend healthcare systems, particularly those serving predominantly older patient groups, adopting online technologies monitor Internet connectivity rates to avoid exacerbating health disparities in their population, the authors were not actually able to control for Internet connectivity in this study. Therefore, they cannot be sure if disparities in registration were a result of lack of opportunity or interest.

“Patient portals that offer access to electronic medical records could help individuals better manage their healthcare and personal needs, but people with less access to and comfort with computers are at risk of not receiving these benefits and will eventually be left behind,” Michael Wolf, corresponding study author and a professor of medicine at Northwestern University Feinberg School of Medicine, said in a statement. “It’s a big concern as the patients that already are, perhaps, less engaged in their health and experiencing worse health outcomes may be further marginalized.”

Beyond the patient portal registration, there were fewer disparities in the use of the patient portal’s functions.

The majority of patients (89.5%) had used the portal to send a message to their physician with the adequate health literacy group, men, and patients with 1 chronic condition more likely to use this function compared with patients with marginal or limited health literacy, women, and patients with no or 2 or more chronic conditions.

Patients were least likely to use the patient portal to check their vital statistics (10.8%), and the researchers found no significant predictors of using this function.

“There were fewer notable disparities in the use of patient portal functions; however, literacy disparities in secure messaging, educational differences in prescription ordering, and race inequalities in checking test results are all cause for concern,” the authors concluded.