Kaiser Permanente Division of Research, Kaiser Permanente Northern California, Pleasanton, CA, United States.
Department of Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, United States.
JMIR Aging. 2024 Nov 7;7:e63814. doi: 10.2196/63814.
Health care systems are increasingly encouraging patients to use patient portals and participate in video visits. However, there is limited information about how portal use differs among older adults.
This study aimed to understand how patient portal and video visit use differed by age, race, and ethnicity among older adult patients with access to the same digital health resources.
This cross-sectional study used electronic health record and survey data for adults aged 65 to 85 years who were members of a large Northern California health care delivery system throughout 2019 and 2020. The electronic health record cohort (N=471,152) included 320,686 White, 35,892 Black, 44,922 Latino, 20,786 Chinese, 28,732 Filipino, 8473 South Asian, 6716 Japanese, 2930 Vietnamese, and 2015 Korean adults. Racial and ethnic group and age group (65 to 75 years vs 76 to 85 years) differences in having a patient portal account by December 2020, the performance of 2 portal activities (sending ≥1 message to a clinician in 2019 or 2020 and viewing ≥1 laboratory test result in 2020), and having ≥1 video visit during 2020 were examined. Modified log-Poisson regression was used to examine prevalence ratios for portal and video visit use, comparing racial and ethnic groups to White adults and Asian ethnic groups to Chinese adults after adjusting for sex and age. Data from a 2020 member survey were used to compare internet use factors among 2867 White, 306 Black, 343 Latino, 225 Chinese, and 242 Filipino adults.
Black, Latino, and Filipino adults were less likely to have a patient portal account than White adults, and Filipino adults were less likely to have a patient portal account than Chinese adults. Black, Latino, Filipino, Korean, Vietnamese, and South Asian adults were less likely to have sent messages and viewed test results than White adults, while Chinese and Japanese adults' use of these features was similar to that of White adults. Filipino, Vietnamese, and Korean adults were less likely to have performed the aforementioned activities than Chinese adults. Video visit use was lower among Black and Latino adults and higher among Chinese and South Asian adults compared with White adults (aged 76 to 85 years) and lower among Filipino, Korean, and Vietnamese adults compared to Chinese adults. Survey data suggested that underlying differences in internet use may partially explain the lower use of messaging by Black, Latino, and Filipino adults compared with White and Chinese adults.
Patient portal and video visit use differed by race, ethnicity, and age group among older adult patients with access to the same patient portal. Internet use factors may contribute to these differences. Differences in patient portal and video visit use across Asian subgroups underscore the importance of disaggregating use data by Asian ethnicity.
医疗保健系统越来越鼓励患者使用患者门户并参与视频访问。然而，关于老年人如何使用门户的信息有限。
本研究旨在了解在可获得相同数字健康资源的情况下，老年患者的患者门户和视频访问使用情况在年龄、种族和民族方面有何不同。
这项横断面研究使用了电子健康记录和 2019 年至 2020 年期间参加加利福尼亚州北部大型医疗服务系统的 65 至 85 岁成年人的调查数据。电子健康记录队列（N=471152）包括 320686 名白人、35892 名黑人、44922 名拉丁裔、20786 名中国人、28732 名菲律宾人、8473 名南亚人、6716 名日本人、2930 名越南人和 2015 名韩国人。研究了到 2020 年 12 月拥有患者门户账户、在 2019 年或 2020 年向临床医生发送≥1 条消息以及在 2020 年查看≥1 项实验室检测结果等 2 项门户活动的表现，以及在 2020 年进行≥1 次视频访问方面的种族和民族差异（65 至 75 岁组与 76 至 85 岁组）。使用修正后的对数泊松回归，在调整性别和年龄后，将每个种族和民族组与白人成年人以及亚裔群体与中国成年人进行比较，以检查门户和视频访问使用的患病率比。使用 2020 年成员调查的数据，比较了 2867 名白人、306 名黑人、343 名拉丁裔、225 名中国人和 242 名菲律宾成年人的互联网使用因素。
黑人、拉丁裔和菲律宾成年人拥有患者门户账户的可能性低于白人成年人，而菲律宾成年人拥有患者门户账户的可能性低于中国人成年人。黑人、拉丁裔、菲律宾、韩国、越南和南亚成年人发送消息和查看检测结果的可能性低于白人成年人，而中国人和日本人成年人使用这些功能的可能性与白人成年人相似。与中国成年人相比，菲律宾人、越南人和韩国成年人更不可能进行上述活动。与白人成年人（76 至 85 岁）相比，黑人、拉丁裔和中国人成年人的视频访问使用率较低，而中国人和南亚成年人的视频访问使用率较高，与中国成年人相比，菲律宾人、韩国人和越南成年人的视频访问使用率较低。调查数据表明，互联网使用方面的潜在差异可能部分解释了与白人成年人和中国成年人相比，黑人、拉丁裔和菲律宾成年人使用消息传递功能的比例较低。
在可获得相同患者门户的情况下，老年患者的患者门户和视频访问使用情况因种族、民族和年龄组而异。互联网使用因素可能是造成这些差异的原因。在亚洲亚组之间的患者门户和视频访问使用差异突出表明，按亚洲族裔细分使用数据的重要性。
