Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Supportive Oncology, Rush University Cancer Center, Chicago, Illinois.
JAMA Netw Open. 2024 Feb 5;7(2):e240680. doi: 10.1001/jamanetworkopen.2024.0680.
Disparities in patient access and use of health care portals have been documented. Limited research has evaluated disparities in portal use during and after the COVID-19 pandemic.
To assess prevalence of health care portal use before, during, and after the most restrictive phase of the pandemic (2019-2022) among the COVID-19 & Chronic Conditions (C3) cohort and to investigate any disparities in use by sociodemographic factors.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study uses data from the C3 study, an ongoing, longitudinal, telephone-based survey of participants with multiple chronic conditions. Participants were middle aged and older-adult primary care patients who had an active portal account, recruited from a single academic medical center in Chicago, Illinois, between 2019 and 2022. Data were analyzed between March and June 2022.
Outcomes of portal use (ie, number of days of portal login by year) were recorded for all study participants by the electronic data warehouse. All parent studies had uniform sociodemographic data and measures of social support, self-efficacy, health literacy, and health activation.
Of 536 participants (mean [SD] age, 66.7 [12.0] years; 336 [62.7%] female), 44 (8.2%) were Hispanic or Latinx, 142 (26.5%) were non-Hispanic Black, 322 (60.1%) were non-Hispanic White, and 20 individuals (3.7%) identified as other race, including Asian, Native American or Alaskan Native, and self-reported other race. In multivariable analyses, portal login activity was higher during the 3 years of the COVID-19 pandemic compared with the 2019 baseline. Higher portal login activity was associated with adequate health literacy (incidence rate ratio [IRR], 1.51; 95% CI, 1.18-1.94) and multimorbidity (IRR, 1.38; 95% CI, 1.17-1.64). Lower portal activity was associated with older age (≥70 years: IRR, 0.69; 95% CI, 0.55-0.85) and female sex (IRR, 0.77; 95% CI, 0.66-0.91). Compared with non-Hispanic White patients, lower portal activity was observed among Hispanic or Latinx patients (IRR, 0.66; 95% CI, 0.49-0.89), non-Hispanic Black patients (IRR, 0.68; 95% CI, 0.56-0.83), and patients who identified as other race (IRR, 0.42; 95% CI, 0.28-0.64).
This cohort study using data from the C3 study identified changes in portal use over time and highlighted populations that had lower access to health information. The COVID-19 pandemic was associated with an increase in portal use. Sociodemographic disparities by sex and age were reduced, although disparities by health literacy widened. A brief validated health literacy measure may serve as a useful digital literacy screening tool to identify patients who need further support.
已有文献记录了患者在使用医疗保健门户方面存在的获取和使用方面的差异。有限的研究评估了在 COVID-19 大流行期间和之后使用门户方面的差异。
评估 COVID-19 & 慢性疾病（C3）队列中患者在大流行最严格阶段（2019-2022 年）之前、期间和之后使用医疗保健门户的流行率，并调查使用情况在社会人口因素方面的任何差异。
设计、设置和参与者：这项队列研究使用了 C3 研究的数据，这是一项正在进行的、纵向的、基于电话的对患有多种慢性疾病的参与者的调查。参与者是中年和老年初级保健患者，他们在 2019 年至 2022 年期间从伊利诺伊州芝加哥的一家学术医疗中心招募，拥有有效的门户账户。数据在 2022 年 3 月至 6 月之间进行了分析。
通过电子数据仓库记录了所有研究参与者的门户使用情况（即每年的门户登录天数）。所有主要研究都有统一的社会人口统计学数据和社会支持、自我效能、健康素养和健康激活的衡量标准。
在 536 名参与者（平均[SD]年龄，66.7[12.0]岁；336[62.7%]女性）中，44 名（8.2%）是西班牙裔或拉丁裔，142 名（26.5%）是非西班牙裔黑人，322 名（60.1%）是非西班牙裔白人，20 名参与者（3.7%）是其他种族，包括亚洲人、美洲原住民或阿拉斯加原住民，以及自我报告的其他种族。在多变量分析中，与 2019 年基线相比，COVID-19 大流行期间的门户登录活动更高。更高的门户登录活动与足够的健康素养（发病率比[IRR]，1.51；95%置信区间[CI]，1.18-1.94）和多种合并症（IRR，1.38；95%CI，1.17-1.64）相关。较低的门户活动与年龄较大（≥70 岁：IRR，0.69；95%CI，0.55-0.85）和女性性别（IRR，0.77；95%CI，0.66-0.91）相关。与非西班牙裔白人患者相比，西班牙裔或拉丁裔患者（IRR，0.66；95%CI，0.49-0.89）、非西班牙裔黑人患者（IRR，0.68；95%CI，0.56-0.83）和自我报告为其他种族的患者（IRR，0.42；95%CI，0.28-0.64）的门户活动较低。
这项使用 C3 研究数据的队列研究确定了随时间变化的门户使用变化，并强调了获取健康信息机会较低的人群。COVID-19 大流行与门户使用增加有关。性别和年龄方面的社会人口差异减少了，尽管健康素养方面的差异扩大了。简短的经过验证的健康素养衡量标准可以作为一种有用的数字素养筛查工具，以确定需要进一步支持的患者。
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