Department of Health Services and Information Management, East Carolina University, Greenville, NC, United States.
Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States.
J Med Internet Res. 2023 Aug 1;25:e44399. doi: 10.2196/44399.
Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited.
This study aimed to explore the factors associated with portal messaging use by rural patients.
We assessed patient portal use among patients with ≥1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient's number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient's home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density.
A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ≥7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income.
Patients' use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity.
患者门户可以促进医疗服务的提供，并支持患有多种慢性疾病的患者进行自我管理。尽管患者门户有这些好处，但农村社区中患有多种合并症的患者使用患者门户的证据有限。
本研究旨在探讨与农村患者门户信息交流使用相关的因素。
我们评估了 2015 年 1 月 1 日至 2021 年 11 月 9 日期间至少有 1 种慢性诊断的患者使用 Epic MyChart（Epic Systems Corporation）门户发送或接收信息的情况。患者门户的使用定义为在研究期间通过门户发送或接收信息。我们根据患者的慢性疾病数量、性别、种族、年龄、婚姻状况和保险类型，使用零膨胀负二项式模型预测门户使用情况。还根据患者的家庭住址纳入了县一级的特征，以评估社区因素对门户使用的影响。县一级的因素包括教育程度、智能手机拥有率、中位数收入和初级保健提供者密度。
共有 65178 名患者（n=38587，59.2%为女性，n=21454，32.92%为黑人）纳入最终数据集，其中 38380 名（58.88%）在 7 年的研究期间至少通过门户发送了 1 条信息。随着慢性诊断数量的增加，门户信息交流使用也随之增加；然而，这种关系主要是由年轻患者驱动的。患有 2 种慢性疾病的患者发送门户信息的可能性是患有 1 种慢性疾病患者的 1.57 倍（P<.001）。相比之下，患有≥7 种慢性疾病的患者发送信息的可能性大约是患有 1 种慢性疾病患者的 11 倍（P<.001）。稳健性检验证实了年龄和诊断数量对门户信息交流的交互作用。在仅包括年龄<65 岁的患者的模型中，与慢性疾病数量相对应的门户信息交流显著增加（P<.001）。相反，对于由老年患者组成的模型，这种关系并不显著。其他与增加门户使用相关的显著因素包括女性；白人；已婚；拥有私人保险；以及生活在教育程度较高、医疗服务提供者密度较大、中位数收入较低的地区。
患者向提供者发送门户信息的使用与他们的诊断数量呈递增关系。随着慢性诊断数量的增加，门户信息交流使用也随之增加。所有年龄段的患者，特别是居住在农村地区的患者，都可以从门户沟通的便利性和成本效益中受益。鼓励医疗保健系统和提供者通过实施教育干预措施来增加患者门户的使用，以促进门户沟通的优势，特别是在患有多种合并症的患者中。
