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Study Shows Race/Ethnicity and Age Disparities in Seniors’ Usage of Patient Portals

March 9, 2016
by Heather Landi
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Patients who are over the age of 69 and Black, Latino and Filipino are less likely to use a healthcare organization’s patient portal which may indicate that these patients are hampered by the eHealth digital divide from obtaining timely health information, according to a study by Kaiser Permanente Northern California.

In the study, which was published in the Journal of Medical Internet Research (JMIR), researchers at Kaiser Permanente Northern California (KPNC) in Oakland, Calif. and Kaiser Permanente Northwest Region in Portland, Ore. sought to assess the extent to which race/ethnic and age-related eHealth digital divides exist among KPNC’s racially and ethnically diverse seniors, and what might be driving the divides.

The study authors concluded, “Our results suggest that the same subgroups of vulnerable seniors that have previously been shown to have difficulties with health care access may also be hampered by the eHealth digital divide from obtaining timely health information and advice, using digital monitoring devices as part of chronic disease self-management, and taking advantage of cost-saving Internet-based care options such as online purchase of prescription medications and medical equipment and having video visits with doctors and patient educators.”

And, the study authors noted, “Because well-known disparities in health status and health care access and use are being extended into the eHealth arena, we do not expect digital technologies to reduce socioeconomic gradients automatically.”

The study examined race/ethnic and age-group differences in overall registration for and patterns of use for four features of the KPNC health plan’s secure patient portal in 2013 in a large study population of non-Hispanic white, black, Hispanic/Latino, Filipino and Chinese adults aged 65 to 79. KPNC is a vertically integrated health care delivery system that serves over 2.4 million adult members and families who mostly reside or work in the San Francisco Bay Area, Silicon Valley, Sacramento area, or the Central Valley in Northern California.

The researchers surveyed patient portal use by 183,565 non-Hispanic white members, 16,898 black members, 12,409 Latino members, 11,896 Filipino members and 6,314 Chinese members aged 65 to 79.

According to the study results, across all racial and ethnic groups, older seniors, or those aged 70 to 79, were significantly less likely than those aged 65 to 69 to have registered to use the patient portal, to have signed into the patient portal at least once and to have used the patient portal to send a secure message, view lab test results online or order prescription refills online at least once by the end of the year.

“Significantly, both our patient portal utilization and survey results affirm that the shift to eHealth has the potential to limit access to two-way exchange of health information for segments of the older adult population who are already more vulnerable to chronic health problems, health care access barriers, and likely poorer outcomes,” the researchers wrote.

And, across all age groups, black, Latino and Filipino health plan members were significantly less likely than non-Hispanic white and Chinese members to have created account by December 31, 2013 and to have used its secure patient portal features. Only 26 percent of black members aged 75 to 79 years used any features on the patient portal at least once in 2013 compared to 56 percent of non-Hispanic white members in the same age group.

“Even among members included in one or more of the health plan’s chronic disease registries, significant age group and race/ethnic differences were observed in use of secure messaging and any of the four patient portal feature,” the researchers wrote in the study.

The researchers also stated, “Using survey data linked to patient portal registration and utilization, we showed that race/ethnic disparities in use of the patient portal were present even among seniors who have the ability to use the Internet. We also showed that seniors with a high school education or less and those who were in fair or poor health were less likely to have used the patient portal than better educated and healthier seniors, respectively, and that within the more vulnerable groups, blacks, Latinos, and Filipinos were less likely to be portal users than non-Hispanic white and Chinese seniors.”

The KPNC researchers also noted that statistics about internet access and preferences for digital engagement that are based on seniors as a group and not broken out by age cohorts and race/ethnicity within age cohorts can provide “a deceptively optimistic picture of seniors’ readiness to engage with patient portals and Web-based information than is the reality for certain segments of the senior population, specifically those who are older, non-white, less educated and lower income.”

The study found disparities in Internet and email access among seniors and also found that the majority of black, Latino and Filipino seniors and close to half of 75 to 79 year olds did not think they would be able to perform many of the most common healthcare-related tasks that could be done using the patient portal and health plan website. And these differences in perceived ability to use and preference for using the patient portal persisted even among those seniors who were internet users.

“This suggests that successful efforts to reduce race/ethnic- and age-related disparities among seniors in use of patient portals and other eHealth modalities and thus reduce the risk of exacerbating disparities in health and health care access will require more than increasing access to the Internet through community-based Wi-Fi or increasing efforts to promote patient portal registration and use,” the study authors wrote.

The study authors recommend that healthcare delivery systems and healthcare organizations that use eHealth initiatives should embed tracking systems and measures of disparities in their access and use. “Health care delivery systems, government agencies and other organizations that serve multiculturally, multilinguistically, multigenerationally and socioeconomically diverse populations should analyze these data to identify access and use gaps for eHealth resources by seniors separately from the broader population,” they wrote.

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