Psychosocial Factors Are Associated with Electronic Portal Registration

• Published in: Clinical orthopaedics and related research 2020-09, Vol.478 (9), p.2079-2084
• Main Authors: Fatehi, Amirreza, Gonzalez, Amanda, Ring, David C., Queralt, Mark
• Format: Article
• Language: English
• Subjects: Adult; Age; Age Factors; Anxiety; Anxiety - psychology; Anxiety disorders; Clinical Research; Communication; Cross-Sectional Studies; Depression - psychology; Electronic medical records; Female; Food security; Healthcare Disparities - statistics & numerical data; Housing; Humans; Language; Male; Mental depression; Middle Aged; Musculoskeletal Diseases - psychology; Neck; Odds Ratio; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Patient Portals - statistics & numerical data; Patients; Physician-Patient Relations; Population studies; Psychosocial Functioning; Registration; Social Class; Surveys and Questionnaires; Telemedicine; Texas
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1097/CORR.0000000000001278

Electronic health records often include a portal for secure patient-clinician communication. There is evidence that use of electronic portals increases satisfaction, treatment adherence, safety, and clinical outcomes. We want everyone to enjoy these benefits and we noticed low and uneven portal use. We studied factors that we can address to improve portal use. After controlling for differences in patient characteristics, what psychological and demographic factors are associated with an increased likelihood of registering for an electronic health record portal among people seeking musculoskeletal specialty care? We reviewed data on 5672 adult English or Spanish-speaking patients seen in a musculoskeletal specialty office between October 2017 and December 2019. Eighteen percent (996 patients) had missing measures of symptoms of depression and anxiety due to intermittent problems with survey technology, leaving 4676 for analysis, 42% (1970 of 4676) men and 58% (2706 of 4676) women with a mean age of 51±15, 76% (3569 of 4676) of patients were English speaking, 22% (1015 of 4676) were Spanish speaking, and 2% (92 of 4676) spoke another language. Seventy-seven percent (3620 of 4676) of patients were residents of Austin, Texas, USA, 4% (159) were from Pflugerville, Texas, USA, 3% (143) were from Del Valle, Texas, USA, and 16% (754 of 4676) were from other areas of Texas. Ninety nine percent of patients were residents of Texas (4645 of 4676). Twenty-three percent of patients visited the upper extremity team (1077 of 4676), 37% the lower extremity team (1721 of 4676), 21% the back and neck team (1002 of 4676), and 19% the sport medicine team (876 of 4676). Seventy eight percent of patients (3654 of 4676) registered in portal and 22% (1022 of 4676) did not. The omitted population were not different from our study population in terms of age, gender, language, residence, and region of symptoms. We used a two-question measure of symptoms of depression (Patient Health Quality-2 [PHQ-2]) and a two-question measure of symptoms of anxiety (General Anxiety Disorder-2 [GAD-2]). The primary outcome was portal registration. To account for potential confounding, a multivariable logistic regressions model was used to determine the influence of age, spoken language, city and state of residence, care team, number of completed visits and GAD and PHQ scores on portal registration. After controlling for potentially confounding variables such as state of residence, we found younger ag