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Background: Electronic patient portals benefit health outcomes;yet, they are underutilized in certain patient sub-populations including adolescents, adults over age 65, racial/ethnic minorities, and non-English-speaking patients. Purpose: This study describes a multi-faceted intervention to increase patient portal use and assesses the program’s effectiveness in these patient subgroups. Method: An intervention was developed with three areas of focus: 1) patient education, 2) provider engagement and education, and 3) health information technology engagement. Baseline data were collected for the entire patient population and segmented by sub-populations of interest. The percentage of patients with an active patient portal were monitored at 12 months and 18 months. Analysis: Logistic regression models examined the change in portal activation over time within sub-populations. Portalactivation increased significantly in all sub-populations examined (ranging from 5-12%), and changes in activation rate within sub-populations were consistent with other patient groups that were higher utilizers. Despite the significant increases, the disparities in portal activation remained. Results: This study suggests that, while disparities were not reduced, a multifaceted intervention involving patient education, provider engagement and education, health information technology increased activation in patient groups that are low utilizers. This increased activation is an important first step toward reducing disparities in patient portal use, which can impact patients’ experiences and outcomes. Patient portals are internet-based services that allow patients to view health records and appointment information and to submit requests for appointments and medication refills. The effective use of online patient portals through which patients can access their health information and communicate with their clinical team members has become increasingly important. The Centers for Medicaid and Medicare Services’ (n.d.) Medicare and Medicaid Promoting Interoperability Program Basics outline requirements for the use of electronic health records, a component of which is provider-to-patient exchange including patient electronic access to personal health information. Further, in the COVID-19 pandemic era during which telemedicine increased across many primary care practices, patient portals are instrumental in bridging care gaps. Patient portals are a potentially under-utilized resource with many actual and perceived barriers to its adoption ( Miller et al., 2016). Patient portal use benefits include improved patient satisfaction, patient-provider communication, patient self-management, and quality of care (Miller et al., 2016;Osborn et al., 2010;Zhong et al., 2020). Improved chronic disease monitoring and overall outcomes associated with diabetes, cholesterol and blood pressure control have been demonstrated among patients using electronic portals (Sorondo et al., 2016;Zhong et al., 2020). Furthermore, patient portal use can increase the utilization of health services resources. Zhong et al., (2020), demonstrated that patients who used a portal for messaging and laboratory functions had lower rates of appointment no-shows compared to non-users. Another study that examined healthcare utilization outcomes following a patient portal education intervention demonstrated a 21% decrease in emergency department admissions (per 1,000) and a 38% decrease in hospital admissions (per 1,000) after seven months (Goel et al., 2011). Despite the benefits of patient portal use, several disparities in activation and engagement are well-documented (elderly, racial and ethnic minorities, low health literacy, chronic illness, insurance status). Compared to non-Hispanic White patients, Latino and African-American patients are less likely to use a patient portal (Sarkar et al., 2011). The Health Information National Trends Survey suggested Hispanic and Black non-Hispanic patients are less likely to use patient portals and were less likely to be offered access to thei patient portal (Clarke et al., 2021). Patients with limited English proficiency (LEP) also lagged behind in patient portal utilization (Ancker et al., 2011). Older adults (aged 65+) are less likely to be willing or able to enroll in and use patient portals (Goel et al., 2011). Adults age 70+ are especially less likely to register for patient portals, own a digital device, use the Internet, or be willing to use an electronic platform for health management. Among older adults who do not use patient portals, common concerns are security of information, lack of personalization, and limited understanding of portal utility (Price-Haywood et al., 2017). Patient stakeholders have recommended strategies to increase portal use in older adults, including explaining to them what patients can do on portals, how to use portals, and why increasing portal use in older adults is useful (Price-Haywood et al., 2017). Another group with notable underutilization of patient portals is adolescents (Goldzweig et al., 2013;Olphert & Damodaran, 2013;Riippa et al., 2014). Despite adolescents being early adopters of technology, uptake of and engagement with patient portals has been challenging. In a feasibility assessment of a portal uptake intervention in adolescents, Ramsey et al., (2018), reported that most intervention participants felt there was a high need for access to the electronic health record through patient portals. Another study in a California detention center suggested 90% of 13-18 year olds were interested in accessing their health information (Irizarry et al., 2015). Despite this interest, rates of patient portal activation in youth are low. Specific Aims The transition to telemedicine for a large portion of patient care at the start of the COVID-19 pandemic placed an urgent emphasis on patient portal use and its benefits. Patient portals are helpful tools to assist patient-provider and patient-nursing communication, appointment scheduling, and the flow of telemedicine visits through delivery of secure links via messaging. The specific aim of this study was to assess the preliminary effectiveness of a practice-level, multi-faceted intervention - engaging patients, providers and information technology - on increasing the activation of patient portals among demographics known for underutilization (Black/African American, Hispanic, adults age 65+, adolescents aged 13-18, and non-English-speaking patients). For patients under age 18, parents could activate the portal as a proxy and use the portal on the child’s behalf. Youth aged 13 and above were allowed confidential access to their patient portal and could grant parents proxy rights. The intervention was developed with the intention to benefit all patients at the practice;however, this study presents the assessment of effectiveness in underutilizers, comparing changes in portal activation status between these patients and the larger patient population. Understanding how practice-wide interventions impact underutilizers can provide beneficial information about whether targeted interventions are needed for sub-populations in the future.
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Objective: Teledentistry conveniently delivers dental care when in-person visits are restricted, such as during the COVID-19 pandemic. This study aimed to assess Saudi Arabian patients' accuracy, perceptions, knowledge, attitudes, and challenges regarding teledentistry used for diagnosis during the COVID-19 pandemic, as well as its accuracy, versus traditional dental visits. Methods: A single-blind, parallel-group randomised controlled trial design was used. The 70 participants were randomised equally into study and control groups. While the control group waited, the study group received teledentistry diagnoses which were compared with baseline clinical examinations retrieved from the UQU dental hospital, Makkah, KSA. After the intervention was completed, all participants answered a questionnaire. Results: There were no significant differences between the groups in knowledge or attitudes regarding teledentistry. However, study group participants had more favourable experiences with teledentistry. They reported good accuracy with diagnosis and recording of their chief complaints (74.3%), number of missing teeth (74.3%), number of filled teeth (71.4%), and oral hygiene status (65.7%). Additionally, moderate accuracy was reported on recording of health complaints (51.4%) and number of decayed teeth (40.?%). The number of decayed teeth and the decayed, missing, and filled teeth (DMF) index scores reported using teledentistry were significantly (p < 0.05) higher than reported in the baseline examinations. Conclusion: Teledentistry is widely accepted by patients and can be efficient for preliminary examinations, particularly during pandemic lockdowns or in more frequently occurring situations such as severe weather conditions, but subsequent clinical examination is necessary for maximally accurate diagnoses.