If you build it, they may not come: modifiable barriers to patient portal use among pre- and post-kidney transplant patients

Abstract

Background Patient access to health information using electronic patient portals is increasingly common. Portal use has the potential to improve patients’ engagement with their health and is particularly important for patients with chronic illness; however, patients’ abilities, attitudes, and use of portals are poorly understood. Methods A single-center, cross-sectional survey was conducted of 240 consecutive pre- and post-kidney transplant patients of all levels of technological proficiency who presented to an urban transplant center in the United States. The investigator-developed Patient Information and Technology Assessment-Patient Portal was used to assess patients’ attitudes towards the use of patient portals. Results Most patients surveyed did not use the patient portal (n = 176, 73%). Patients were more likely to use the patient portal if they were White, highly educated, in the post-transplant period, more comfortable with technology, and reported being a frequent internet user (P < .05). The most common reasons for not using the patient portal included: (1) preference for traditional communication, (2) not being aware of the portal, (3) low technological proficiency, and (4) poor interoperability between the portal at the transplant center and the patient’s primary care center. Conclusions We identified several modifiable barriers to patient portal use. Some barriers can be addressed by patient education and training on portal use, and federal initiatives are underway to improve interoperability; however, a preference for traditional communications represents the most prominent barrier. Additional strategies are needed to improve portal adoption by encouraging acceptance of technologies as a way of clinical communication.

Patient Portal Barriers and Group Differences: Cross-Sectional National Survey Study (Preprint)

“…Consistent with previous studies, our study indicated that patient preference for in-person communication with providers serves as a barrier to patient portal adoption [38,[46][47][48][49]. This study extends prior studies by demonstrating that this barrier may be more common (1810/2828, 64.00%) than previously thought and that certain patient demographics are associated with preferring in-person communication (eg, women, older patients, and patients with lower income and education).…”

“…It is possible that other important barriers may have been omitted. The survey questions do, however, capture many of the barriers reported in prior portal studies [38,[46][47][48][49], suggesting that the questions align well with prior research. Third, the HINTS response rate was around 30%, so it is possible that the findings are not representative of the entire sample owing to nonresponse bias.…”

Quantifying Patient Portal Use: Systematic Review of Utilization Metrics

“…A patient portal is a secure online website, managed by a health care organization, that provides patients access to their personal health information [1][2][3]. Portals were developed to provide patients with a platform through which to claim ownership over their health care.…”

Comparing Characteristics of Patients Who Connect Their iPhones to an Electronic Health Records System Versus Patients Who Connect Without Personal Devices: Cohort Study

“…PHRs and patient portals have existed for decades in various forms, though there has been significant expansion of these technologies in the last decade driven by overall technological advancements and US federal regulatory requirements in the form of Meaningful Use (now called Promoting Interoperability). Prior work has shown that, overall, patient portal usage seems to be increasing [23,24] but remains low, with typically less than 50% of patients using online portals [9,10,25]. Additionally, prior work has shown that patient portal use may reflect or exacerbate a digital divide between sociodemographic patient groups.…”

“…Pho et al and Gerber et al [23,24] showed that in an oncology population, certain characteristics were more associated with portal usage, such as younger age, Caucasian race, and Spanish-speaking patients. Lockwood et al [9] also demonstrated important sociodemographic differences in portal usage in a pre and post-kidney transplant population. These, and our findings, exist within a broader literature describing a very real digital divide between patients who do not have ready access to the internet due to literacy, cost, or other barriers, and those that do have immediate access [26-31].…”