Lyles Courtney R, Tieu Lina, Sarkar Urmimala, Kiyoi Stephen, Sadasivaiah Shobha, Hoskote Mekhala, Ratanawongsa Neda, Schillinger Dean
From the Center for Vulnerable Populations (CRL, LT, US, MH, NR, DS), Division of General Internal Medicine (CRL, LT, US, MH, NR, DS), UCSF Division of Hospital Medicine (SS), Zuckerberg San Francisco General Hospital Library (SK), University of California-San Francisco, San Francisco, CA; Jonathan and Karin Fielding School of Public Health, University of California-Los Angeles, Los Angeles (LT); Office of Health Informatics, San Francisco Health Network, San Francisco (SS).
J Am Board Fam Med. 2019 Mar-Apr;32(2):248-258. doi: 10.3122/jabfm.2019.02.180263.
Patient portals are becoming ubiquitous. Previous research has documented substantial barriers, especially among vulnerable patient subgroups such as those with lower socioeconomic status or limited health literacy (LHL). We tested the effectiveness of delivering online, video-based portal training to patients in a safety net setting.
We created an online video curriculum about accessing the San Francisco Health Network portal, and then randomized 93 English-speaking patients with 1+ chronic diseases to receive 1) an in-person tutorial with a research assistant, or 2) a link to view the videos on their own. We also examined a third, nonrandomized usual care comparison group. The primary outcome was portal log-in (yes/no) 3 to 6 months post-training, assessed via the electronic health record. Secondary outcomes were self-reported attitudes and skills collected via baseline and follow-up surveys.
Mean age was 54 years, 51% had LHL, 60% were nonwhite, 52% were female, 45% reported fair/poor health, and 76% reported daily Internet use. At followup, 21% logged into the portal, with no differences by arm ( = .41), but this was higher than the overall clinic rate of 9% ( < .01) during the same time period. We found significant prepost improvements in self-rated portal skills ( = .03) and eHealth literacy ( < .01). Those with LHL were less likely to log in post-training ( < .01).
Both modalities of online training were comparable, and neither mode enabled a majority of vulnerable patients to use portals, especially those with LHL. This suggests that portal training will need to be more intensive or portals need improved usability to meaningfully increase use among diverse patients.
患者门户网站正变得无处不在。先前的研究记录了诸多重大障碍，尤其是在社会经济地位较低或健康素养有限（LHL）等弱势患者亚组中。我们测试了在安全网环境下为患者提供基于视频的在线门户网站培训的效果。
我们创建了一个关于访问旧金山健康网络门户网站的在线视频课程，然后将93名患有1种及以上慢性病的英语患者随机分为两组，分别接受：1）由研究助理进行的面对面辅导，或2）自行观看视频的链接。我们还研究了第三个非随机的常规护理对照组。主要结局是培训后3至6个月的门户网站登录情况（是/否），通过电子健康记录进行评估。次要结局是通过基线和随访调查收集的自我报告态度和技能。
平均年龄为54岁，51%的人健康素养有限，60%为非白人，52%为女性，45%报告健康状况为一般/较差，76%报告每天使用互联网。在随访时，21%的人登录了门户网站，各分组之间无差异（P = 0.41），但这高于同期诊所9%的总体登录率（P < 0.01）。我们发现自评门户网站技能（P = 0.03）和电子健康素养（P < 0.01）在前后有显著改善。健康素养有限的人在培训后登录的可能性较小（P < 0.01）。
两种在线培训方式具有可比性，但两种方式都未能使大多数弱势患者使用门户网站，尤其是那些健康素养有限的患者。这表明门户网站培训需要更深入，或者门户网站需要提高可用性，才能切实增加不同患者群体的使用率。
