Lyles Courtney Rees, Allen Jill Y, Poole Dolly, Tieu Lina, Kanter Michael H, Garrido Terhilda
University of California San Francisco, San Francisco, CA, United States.
J Med Internet Res. 2016 Oct 3;18(10):e263. doi: 10.2196/jmir.5910.
Despite the widespread implementation of electronic health records (EHRs), there is growing evidence that racial/ethnic minority patients do not use portals as frequently as non-Hispanic whites to access their EHR information online. This differential portal use could be problematic for health care disparities since early evidence links portal use to better outcomes.
We sought to understand specific barriers to portal use among African American and Latino patients at Kaiser Permanente, which has had a portal in place for over a decade, and broad uptake among the patient population at large.
We conducted 10 focus groups with 87 participants in 2012 and 2013 among African American and Latino Kaiser Permanente members in the mid-Atlantic, Georgia, and Southern California regions. Members were eligible to participate if they were not registered for portal access. Focus groups were conducted within each racial/ethnic group, and each included individuals who were older, had a chronic disease, or were parents (as these are the three biggest users of the portal at Kaiser Permanente overall). We videotaped each focus group and transcribed the discussion for analysis. We used general inductive coding to develop themes for major barriers to portal use, overall and separately by racial/ethnic group.
We found that lack of support was a key barrier to initiating portal use in our sample-both in terms of technical assistance as well as the fear of the portal eroding existing personal relationships with health care providers. This held true across a range of focus groups representing a mix of age, income, health conditions, and geographic regions.
Our study was among the first qualitative explorations of barriers to portal use among racial/ethnic subgroups. Our findings suggest that uniform adoption of portal use across diverse patient groups requires more usable and personalized websites, which may be particularly important for reducing health care disparities. This work is particularly important as all health care systems continue to offer and promote more health care features online via portals.
尽管电子健康记录（EHRs）已广泛实施，但越来越多的证据表明，少数族裔患者在线访问其EHR信息的频率不如非西班牙裔白人使用门户频繁。这种门户使用差异可能对医疗保健差距产生问题，因为早期证据将门户使用与更好的结果联系起来。
我们试图了解凯撒医疗集团（Kaiser Permanente）中非洲裔美国人和拉丁裔患者使用门户的具体障碍，该集团拥有一个已存在十多年的门户，并且在广大患者群体中得到广泛采用。
2012年和2013年，我们在大西洋中部、佐治亚州和南加州地区对87名凯撒医疗集团的非洲裔美国人和拉丁裔成员进行了10次焦点小组讨论。如果成员未注册门户访问，则有资格参加。在每个种族/族裔群体中进行焦点小组讨论，每个小组都包括年龄较大、患有慢性病或为人父母的个体（因为这些是凯撒医疗集团总体上门户的三大主要用户群体）。我们对每个焦点小组进行录像，并转录讨论内容进行分析。我们使用一般归纳编码来确定门户使用主要障碍的主题，总体上以及按种族/族裔群体分别确定。
我们发现，在我们的样本中，缺乏支持是启动门户使用的关键障碍——无论是在技术援助方面，还是担心门户会侵蚀与医疗保健提供者现有的个人关系。在代表不同年龄、收入、健康状况和地理区域的一系列焦点小组中都是如此。
我们的研究是对种族/族裔亚组中门户使用障碍的首批定性探索之一。我们的研究结果表明，在不同患者群体中统一采用门户使用需要更易用且个性化的网站，这对于减少医疗保健差距可能尤为重要。随着所有医疗保健系统继续通过门户在线提供和推广更多医疗保健功能，这项工作尤为重要。
