Frequency of and Factors Associated with Care Partner Proxy Interaction with Health Care Teams Using Patient Portal Accounts

Pecina, Jennifer L; Duvall, Michelle J.; North, Frederick

doi:10.1089/tmj.2019.0208

Cited by 19 publications

(21 citation statements)

References 16 publications

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“…We observed similar issues across the age span from adolescents through older adults, with care partners (from parents of adolescents to adult children of older adults) primarily accessing the patient portal using patient log-in credentials. 51,71 Both patients and care partners were found to express preferences for improved functionality around proxy access. 46 Our findings suggest the relevance of organizational factors in care partner uptake of the patient portal but do not indicate specific health system policy, technology, or workflows that facilitate proxy access and instead demonstrate inconsistent policies, features, and awareness surrounding proxy access.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations

et al. 2022

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ImportanceFamily and other unpaid care partners may bridge accessibility challenges in interacting with the patient portal, but the extent and nature of this involvement is not well understood.ObjectiveTo inform an emerging research agenda directed at more purposeful inclusion of care partners within the context of digital health equity by (1) quantifying care partners’ uptake and use of the patient portal in adolescent and adult patients, (2) identifying factors involving care partners’ portal use across domains of the System Engineering Initiative for Patient Safety model, and (3) assessing evidence of perceived or actual outcomes of care partners’ portal use.Evidence ReviewFollowing Arksey and O’Malley’s methodologic framework, a scoping review of manuscripts published February 1 and March 22, 2022, was conducted by hand and a systematic search of PubMed, PsycInfo, Embase, and Web of Science. The search yielded 278 articles; 125 were selected for full-text review and 41 were included.FindingsFew adult patient portal accounts had 1 or more formally registered care partners (&lt;3% in 7 of 7 articles), but care partners commonly used the portal (8 of 13 contributing articles reported &gt;30% use). Care partners less often authored portal messages with their own identity credentials (&lt;3% of portal messages in 3 of 3 articles) than with patient credentials (20%-60% of portal messages in 3 of 5 articles). Facilitators of care partner portal use included markers of patient vulnerability (13 articles), care partner characteristics (15 articles; being female, family, and competent in health system navigation), and task-based factors pertaining to ease of information access and care coordination. Environmental (26 articles) and process factors (19 articles, eg, organizational portal registration procedures, protection of privacy, and functionality) were identified as influential to care partner portal use, but findings were nuanced and precluded reporting on effects. Care partner portal use was identified as contributing to both patient and care partner insight into patient health (9 articles), activation (7 articles), continuity of care (8 articles), and convenience (6 articles).Conclusions and RelevanceIn this scoping review, care partners were found to be infrequently registered for the patient portal and more often engaged in portal use with patient identity credentials. Formally registering care partners for the portal was identified as conferring potential benefits for patients, care partners, and care quality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations

et al. 2022

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“…As health systems are increasingly screening patients for unmet social needs (e.g., housing instability), this could be an important area for future research and clinical care. Fifth, because of the low frequency of messages sent through a proxy account and the challenges with distinguishing messages sent through patient or proxy, 46 we did not distinguish between portal usage performed by a patient account versus a proxy account.…”

Section: Limitationsmentioning

confidence: 99%

Characteristics of Adult Primary Care Patients Who Use the Patient Portal: A Cross-Sectional Analysis

et al. 2022

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Background: The patient portal allows patients to engage with their healthcare team beyond the clinical encounter. While portals can improve patient outcomes, there may be disparities in which patients access the portal by sociodemographic factors. Understanding the characteristics of patients who use the portal could help design future interventions to expand portal adoption. Objectives: This study aimed to (1) examine the socioeconomic factors, comorbid conditions, and healthcare utilization among patients of a large academic primary care network who are users and non-users of the patient portal; and (2) describe the portal functions most frequently utilized. Methods: We included all adult patients at Atrium Health Wake Forest Baptist who had at least two primary care visits between 2018 and 2019. Patients' demographics, comorbidities, healthcare utilization, and portal function usage were extracted from the electronic health record and merged with census data (income, education, and unemployment) from the American Community Survey. A myWakeHealth portal user was defined as a patient who used a bidirectional portal function at least once during the study period. We used multivariable logistic regression to determine which patient characteristics were independently associated with being a portal user. Results: Of the 178,720 patients who met inclusion criteria, 32% (N=57,122) were users of myWakeHealth. Compared to non-users, users were more likely to be 18-64 years of age, female, non-Hispanic white, married, commercially insured, have higher disease burden, and have lower healthcare utilization. Patients residing in areas with the highest educational attainment had 51% higher odds of being a portal user than the lowest (p<0.001). Among portal users, the most commonly used function was messaging clinic providers. Conclusions: We found that patient demographics and area socioeconomic factors were associated with patient portal adoption. These findings suggest that efforts to improve portal adoption should be targeted at vulnerable patients.

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“…Although shared portal access is reportedly desired by patients and valued by families [ 2 , 9 - 11 ], uptake has been limited [ 12 - 14 ]. Studies involving convenience samples from care delivery organizations indicate that when care partners do access the portal, it is most often informally, using patient identity credentials [ 13 - 17 ]. In a recent study involving a text analysis of 3000 adult portal messages, care partners who direct messaged clinicians with patient credentials identified themselves about half of the time [ 17 ].…”

Section: Shared Portal Access: the Current Landscapementioning

confidence: 99%

Shared Access to Patient Portals for Older Adults: Implications for Privacy and Digital Health Equity

Wolff¹,

Dukhanin²,

Burgdorf³

et al. 2022

JMIR Aging

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Growing reliance on the patient portal as a mainstream modality in health system interactions necessitates prioritizing digital health equity through systems-level strategies that acknowledge and support all persons. Older adults with physical, cognitive, sensory, and socioeconomic vulnerabilities often rely on the involvement of family and friends in managing their health, but the role of these care partners in health information technology is largely undefined and poorly understood. This viewpoint article discusses challenges and opportunities of systematic engagement of care partners through shared access to the patient portal that have been amplified in the context of the COVID-19 outbreak and recent implementation of federal information blocking rules to promote information transparency alongside broader shifts toward care delivery innovation and population aging. We describe implementation considerations and the promise of granular, role-based privacy controls in addressing the nuanced and dynamic nature of individual information sharing preferences and fostering person- and family-centered care delivery.

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Frequency of and Factors Associated with Care Partner Proxy Interaction with Health Care Teams Using Patient Portal Accounts

Cited by 19 publications

References 16 publications

Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations

Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations

Characteristics of Adult Primary Care Patients Who Use the Patient Portal: A Cross-Sectional Analysis

Shared Access to Patient Portals for Older Adults: Implications for Privacy and Digital Health Equity

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