Ukoha Erinma P, Feinglass Joe, Yee Lynn M
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States.
Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
J Med Internet Res. 2019 Sep 23;21(9):e14445. doi: 10.2196/14445.
Electronic patient portals are websites that provide individuals access to their personal health records and allow them to engage through a secure Web-based platform. These portals are becoming increasingly popular in contemporary health care systems. Patient portal use has been found to be beneficial in multiple specialties, especially in the management of chronic disease. However, disparities have been identified in portal use in which racial and ethnic minorities and individuals with lower socioeconomic status have been shown to be less likely to enroll and use patient portals than non-Hispanic white persons and individuals with higher socioeconomic status. Electronic patient portal use by childbearing women has not been well studied, and data on portal use during pregnancy are limited.
This study aimed to quantify the use of an electronic patient portal during pregnancy and examine whether disparities related to patients' demographics or clinical characteristics exist.
This was a retrospective cohort study of women who received prenatal care at an academic medical center from 2014 to 2016. Clinical records were reviewed for portal use and patient data. Patients were considered enrolled in the portal if they had an account at the time of delivery, and enrollees were compared with nonenrollees. Enrollees were further categorized based on the number of secure messages sent during pregnancy as active (≥1) or inactive (0) users. Bivariable chi-square and multivariable Poisson regression models were used to calculate the incidence rate ratio of portal enrollment and, if enrolled, of active use based on patients' characteristics.
Of the 3450 women eligible for inclusion, 2530 (73.33%) enrolled in the portal. Of these enrollees, 72.09% (1824/2530) were active users. There was no difference in portal enrollment by maternal race and ethnicity on multivariable models. Women with public insurance (adjusted incidence rate ratio; aIRR 0.60, 95% CI 0.49-0.84), late enrollment in prenatal care (aIRR 0.78, 95% CI 0.69-0.89 for second trimester and aIRR 0.50, 95% CI 0.39-0.64 for third trimester), and high-risk pregnancies (aIRR 0.82, 95% CI 0.75-0.89) were significantly less likely to enroll. Conversely, nulliparity (aIRR 1.10, 95% CI 1.02-1.20) and having more than 8 prescription medications at prenatal care initiation (aIRR 1.19, 95% CI 1.06-1.32) were associated with greater likelihood of enrollment. Among portal enrollees, the only factor significantly associated with active portal use (ie, secure messaging) was nulliparity (aIRR 1.11, 95% CI 1.01-1.23).
Among an obstetric population, multiple clinical and socioeconomic factors were associated with electronic portal enrollment, but not subsequent active use. As portals become more integrated as tools to promote health, efforts should be made to ensure that already vulnerable populations are not further disadvantaged with regard to electronic-based care.
电子患者门户网站是一些网站，可为个人提供访问其个人健康记录的途径，并允许他们通过安全的基于网络的平台进行互动。这些门户网站在当代医疗保健系统中越来越受欢迎。已发现患者门户网站的使用在多个专科中有益，尤其是在慢性病管理方面。然而，在门户网站使用方面已发现存在差异，其中少数族裔和社会经济地位较低的个人比非西班牙裔白人及社会经济地位较高的个人注册和使用患者门户网站的可能性更低。关于育龄妇女使用电子患者门户网站的情况尚未得到充分研究，且孕期门户网站使用的数据有限。
本研究旨在量化孕期电子患者门户网站的使用情况，并检查是否存在与患者人口统计学或临床特征相关的差异。
这是一项对2014年至2016年在一家学术医疗中心接受产前护理的妇女进行的回顾性队列研究。审查临床记录以获取门户网站使用情况和患者数据。如果患者在分娩时拥有账户，则被视为已注册该门户网站，并将注册者与未注册者进行比较。根据孕期发送的安全消息数量，将注册者进一步分类为活跃（≥1条）或不活跃（0条）用户。使用双变量卡方检验和多变量泊松回归模型根据患者特征计算门户网站注册的发病率比，以及如果已注册则计算活跃使用的发病率比。
在3450名符合纳入条件的妇女中，2530名（73.33%）注册了该门户网站。在这些注册者中，72.09%（1824/2530）是活跃用户。在多变量模型中，产妇种族和民族在门户网站注册方面没有差异。有公共保险的妇女（调整后的发病率比；aIRR 0.60，95% CI 0.49 - 0.84）、产前护理登记较晚（孕中期aIRR 0.78，95% CI 0.69 - 0.89；孕晚期aIRR 0.50，95% CI 0.39 - 0.64）以及高危妊娠（aIRR 0.82，95% CI 0.75 - 0.89）的妇女注册的可能性显著较低。相反，初产（aIRR 1.10，95% CI 1.02 - 1.20）以及在开始产前护理时服用超过8种处方药（aIRR 1.19，95% CI 1.06 - 1.32）与更高的注册可能性相关。在门户网站注册者中，与活跃的门户网站使用（即安全消息传递）显著相关的唯一因素是初产（aIRR 1.11，95% CI 1.01 - 1.23）。
在产科人群中，多种临床和社会经济因素与电子门户网站注册相关，但与随后的活跃使用无关。随着门户网站作为促进健康的工具变得更加一体化，应努力确保本就脆弱的人群在基于电子的护理方面不会进一步处于不利地位。
