Smith Samuel G, O'Conor Rachel, Aitken William, Curtis Laura M, Wolf Michael S, Goel Mita Sanghavi
Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA.
J Am Med Inform Assoc. 2015 Jul;22(4):888-95. doi: 10.1093/jamia/ocv025. Epub 2015 Apr 25.
To document disparities in registration and use of an online patient portal among older adults.
Data from 534 older adults were linked with information from the Northwestern Medicine Electronic Data Warehouse on patient portal registration and use of functions (secure messaging, prescription reauthorizations, checking test results, and monitoring vital statistics). Age, gender, race, education, self-reported chronic conditions, and the Newest Vital Sign health literacy measure were available from cohort data.
Most patients (93.4%) had a patient portal access code generated for them, and among these 57.5% registered their accounts. In multivariable analyses, White patients (P < .001) and college graduates were more likely to have registered their patient portal (P = .015). Patients with marginal (P = .034) or adequate (P < .001) health literacy were also more likely to have registered their patient portal. Among those registering their accounts, most had messaged their physician (90%), checked a test result (96%), and ordered a reauthorization (55%), but few monitored their vital statistics (11%). Adequate health literacy patients were more likely to have used the messaging function (P = .003) and White patients were more likely to have accessed test results (P = .004). Higher education was consistently associated with prescription reauthorization requests (all P < .05).
Among older American adults, there are stark health literacy, educational, and racial disparities in the registration, and subsequent use of an online patient portal. These population sub-group differences may exacerbate existing health disparities.
If patient portals are implemented, intervention strategies are needed to monitor and reduce disparities in their use.
记录老年人在线患者门户注册及使用情况的差异。
534名老年人的数据与西北医学电子数据仓库中关于患者门户注册及功能使用（安全消息传递、处方重新授权、查看检查结果和监测生命体征）的信息相关联。队列数据提供了年龄、性别、种族、教育程度、自我报告的慢性病情况以及最新生命体征健康素养测量数据。
大多数患者（93.4%）有为其生成的患者门户访问代码，其中57.5%注册了账户。在多变量分析中，白人患者（P < 0.001）和大学毕业生更有可能注册其患者门户（P = 0.015）。健康素养处于边缘水平（P = 0.034）或足够水平（P < 0.001）的患者也更有可能注册其患者门户。在注册账户的患者中，大多数人给医生发过消息（90%）、查看过检查结果（96%）并申请过重新授权（55%），但很少有人监测自己的生命体征（11%）。健康素养足够的患者更有可能使用消息传递功能（P = 0.003），白人患者更有可能查看检查结果（P = 0.004）。高等教育始终与处方重新授权请求相关（所有P < 0.05）。
在美国老年成年人中，在线患者门户的注册及后续使用在健康素养、教育程度和种族方面存在明显差异。这些人群亚组差异可能会加剧现有的健康差异。
如果实施患者门户，需要采取干预策略来监测并减少其使用中的差异。
