The Digital Divide and Patient Portals: Internet Access Explained Differences in Patient Portal Use for Secure Messaging by Age, Race, and Income

BACKGROUND:Online access to health records and the ability to exchange secure messages with physicians can improve patient engagement and outcomes; however, the digital divide could limit access to web-based portals among disadvantaged groups. OBJECTIVES:To understand whether sociodemographic differ...

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Bibliographic Details
Published in:Medical care 2016-08, Vol.54 (8), p.772-779
Main Authors: Graetz, Ilana, Gordon, Nancy, Fung, Vick, Hamity, Courtnee, Reed, Mary E.
Format: Article
Language:English
Subjects:
Access to Information
Adult
Age Factors
Computer Security
Continental Population Groups
Cross-Sectional Studies
Demography
Diffusion of Innovation
Digital divide
Electronic Health Records
Female
Health Services Accessibility
Humans
Income
Internet
Internet access
Male
Middle Aged
Original Article
Patient Participation
Patient Preference
Sociodemographics
Web portals
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Summary:BACKGROUND:Online access to health records and the ability to exchange secure messages with physicians can improve patient engagement and outcomes; however, the digital divide could limit access to web-based portals among disadvantaged groups. OBJECTIVES:To understand whether sociodemographic differences in patient portal use for secure messaging can be explained by differences in internet access and care preferences. RESEARCH DESIGN:Cross-sectional survey to examine the association between patient sociodemographic characteristics and internet access and care preferences; then, the association between sociodemographic characteristics and secure message use with and without adjusting for internet access and care preference. SUBJECTS:One thousand forty-one patients with chronic conditions in a large integrated health care delivery system (76% response rate). MEASURES:Internet access, portal use for secure messaging, preference for in-person or online care, and sociodemographic and health characteristics. RESULTS:Internet access and preference mediated some of the differences in secure message use by age, race, and income. For example, using own computer to access the internet explained 52% of the association between race and secure message use and 60% of the association between income and use (Sobel-Goodman mediation test, P
ISSN:0025-7079
1537-1948
DOI:10.1097/MLR.0000000000000560