Ahmed N, Brown J, Parau C, McCullers A, Sanghavi K, Littlejohn R, Wesley D. Bridging the Digital Health Divide: Characterizing Patient Portal Users and Nonusers in the U.S. Med Care. 2023;61(7):448-455.
Increasing access to digital patient portals is critical for moving the healthcare field forward. Patient portals reduce overhead and streamline patient and provider access to records and test results while providing secure communications outside increasingly brief face-to-face meetings. Despite the benefits, uptake remains challenging. To understand the differences between users and non-users, 489 self-selecting participants completed an online survey collecting demographic information, participants’ knowledge, skills, and confidence for self-management of chronic conditions (Patient Activation Measure (PAM)), health literacy (BRIEF Health Literacy Screening Tool (BRIEF)), and measures of their media and technology literacy and use (Media and Technology Usage and Attitudes Scale (MTUAS)). Compared to the individuals who did not use patient portals, users were more likely to have formal education after high school (p < 0.001) and live in urban areas (p = 0.03). Individuals with active health insurance (p < 0.001), a primary care physician (p < 0.001), or disability/chronic conditions (p < 0.001) were more likely to use the patient portal. Individuals who used patient portals showed higher confidence in managing a chronic condition (PAM, p < 0.001) and more positive technology attitudes (MTUAS, p = 0.002) compared to non-users. Contrary to expectations, non-users showed higher health literacy (BRIEF inadequate literacy 61.1%) than users (70.0%). Together this data provides interesting insight into a section of the population familiar with the internet (volunteered for an online survey) but evenly mixed on the use of patient portals (users n = 263, non-users n = 226). Further research is needed to explain why higher health literacy would discourage people from engaging with a patient portal. It is possible, as the authors suggested, that individuals who feel they can accurately read health materials to answer questions they may have about their care would render the portal and unnecessary step in care-management.