A Randomized Trial to Train Vulnerable Primary Care Patients to Use a Patient Portal.

BACKGROUND: 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. METHODS: 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. RESULTS: 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 (P = .41), but this was higher than the overall clinic rate of 9% (P < .01) during the same time period. We found significant prepost improvements in self-rated portal skills (P = .03) and eHealth literacy (P < .01). Those with LHL were less likely to log in post-training (P < .01). CONCLUSIONS: 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.

Disparities in Patient-Reported Interest in Web-Based Patient Portals: Survey at an Urban Academic Safety-Net Hospital.

BACKGROUND: Offering hospitalized patients' enrollment into a health system's patient portal may improve patient experience and engagement throughout the care continuum, especially across care transitions, but this process is less studied than portal engagement in the ambulatory setting. Patient portal disparities exist and may lead to differences in access or outcomes. As such, it is important to study upstream factors in a typical hospital workflow that could lead to those disparities in safety-net settings. OBJECTIVE: The objective of this study was to evaluate sociodemographic characteristics associated with interest in a health care system's portal among hospitalized patients and reasons for no interest. METHODS: Nurses assessed interest in a Web-based patient portal, expressed by the patient as "yes" or "no," as part of the admission nursing assessment among patients at an academic urban safety-net hospital and recorded responses in the electronic health record (EHR), including reasons for no interest. We extracted patient responses from the EHR. RESULTS: Among 23,994 hospitalizations over a 2-year period, 35.90% (8614/ 23,994) reported an interest in a Web-based portal. Reasons for no interest included the following: not interested/other reason 41.68% (6410/15,380), no ability to use/access computers/internet 29.59% (4551/15,380), doesn't speak English 11.15% (1715/15,380), physically or mentally unable 8.70% (1338/15,380), does not want to say 8.70% (1338/15,380), security concerns 0.03% (4/15,380), and not useful 0.16% (24/15,380). Among the 16,507 unique patients included in this sample, portal interest was lower in older, African American, non-English speaking, and homeless patient populations. CONCLUSIONS: In a safety-net system, patient interest at the time of hospitalization in a Web-based enterprise portal-a required step before enrollment-is low with significant disparities by sociodemographic characteristics. To avoid worsening the digital divide, new strategies are needed and should be embedded within routine workflows to engage vulnerable safety-net patients in the use of Web-based health technologies.