Patient portals have benefits – but not everyone can access them
A study published this week in Kidney Medicine found that although electronic health record portals are increasingly emphasized in chronic kidney disease treatment, interventions are needed to ensure all patients have access to these tools.
Led by researchers from the University of Michigan, the University of Utah and the University of Vanderbilt, the study examined whether kidney function was associated with portal use at one large medical system.
"Chronic kidney disease is highly prevalent and contributes to substantial morbidity and mortality," the study team wrote. "Yet many patients are not fully engaged in their care, and remain unaware of their diagnosis and its implications."
"There exist opportunities to strengthen management by educating patients about CKD and increasing engagement through effective patient-provider communication," they added. "Electronic health record patient portals may provide one strategy to enhance patient-provider communication, optimize information sharing, and allow patients to be more engaged in CKD care."
WHY IT MATTERS
Patient portals offer a way for individuals to stay involved with their own care by accessing their personal records online or, in some cases, being connected with further educational resources.
Prior studies have shown that Black patients, older patients and patients whose primary insurance is Medicaid were less likely to use portals than white patients, younger patients and those with other forms of insurance. But, the researchers noted, the association of health portal use and clinical outcomes remains "poorly characterized."
"As portals are increasingly adopted and promoted, it is important to understand how portal use may associate with clinical and patient-reported outcomes that are important to patients," they wrote.
This study examined whether four patient-centered outcomes – disease knowledge, disease-related stress, self-rating of current health status and self-rating of health compared to one year ago – could be predicted by portal use.
Researchers found that both knowledge and health status were higher in those using the portal, and that disease-related stress was lower. However, in an adjusted analysis, only income and/or disease severity independently predicted patient-centered outcomes; portal use was not associated with kidney function.
"Possible explanations for higher CKD knowledge with portal use are that the portal gives patients personalized access to their health information in addition to access to a variety of different educational resources," they explained.
"Portal use may also allow patients to derive comfort, and in turn lower disease related stress, through viewing labs or results or by communicating with members of the healthcare team. Alternatively, since this study is cross-sectional, it may be that portals are simply used by patients who are healthier or more knowledgeable –and who have the resources to get access to computers and online information," they continued.
However, in an adjusted analysis, those with lower incomes were less likely to use the patient portal – suggesting that work is needed to ensure portals address care needs for all patients.
"An important point is that while many health systems promote patient portals, there remain an important subsets of patients who are not receiving the intended gains from portals which causes concern that while well intended, portals may instead widen disparities in care for those most vulnerable instead of improving access to care for all," they wrote.
THE LARGER TREND
The study complements other examinations of patients' use of portals, including a wide-ranging Journal of the American Medical Association Network Open study from this past summer that found early adopters of direct scheduling were more likely to be young, white and commercially insured.
"Even among patients with portal access, those who are socioeconomically disadvantaged are less likely to use the technology," wrote those researchers.
Indeed, although patient portals have been found to improve efficiency and engagement, some patients say they're confusing and time-consuming – to say nothing of the digital divide making it harder for some people to get online in the first place.
ON THE RECORD
"Although the patient portals can be useful to our patients in many ways, further work is needed to ensure that wide promotion of health portals addresses care needs for all patients and does not instead widen existing disparities in care across the continuum of [chronic kidney disease]," wrote the Kidney Medicine study authors.
Focus on Health Equity
This month we will be reporting on the challenges, opportunities and success stories as work continues to build a healthcare system that works for everyone.