Background
Patient portals have the
potential to support self-management for chronic diseases and improve health
outcomes. With the rapid rise in adoption of patient portals spurred by
meaningful use incentives among safety net health systems (a health system or
hospital providing a significant level of care to low-income, uninsured, and
vulnerable populations), it is important to understand the readiness and
willingness of patients and caregivers in safety net settings to access their
personal health records online.
Objective
To explore patient and
caregiver perspectives on online patient portal use before its implementation
at San Francisco General Hospital, a safety net hospital.
Methods
We conducted 16 in-depth
interviews with chronic disease patients and caregivers who expressed interest
in using the Internet to manage their health. Discussions focused on health
care experiences, technology use, and interest in using an online portal to manage
health tasks. We used open coding to categorize all the barriers and
facilitators to portal use, followed by a second round of coding that compared
the categories to previously published findings. In secondary analyses, we also
examined specific barriers among 2 subgroups: those with limited health
literacy and caregivers.
Results
We interviewed 11
patients and 5 caregivers. Patients were predominantly male (82%, 9/11) and
African American (45%, 5/11). All patients had been diagnosed with diabetes and
the majority had limited health literacy (73%, 8/11). The majority of
caregivers were female (80%, 4/5), African American (60%, 3/5), caregivers of
individuals with diabetes (60%, 3/5), and had adequate health literacy (60%,
3/5). A total of 88% (14/16) of participants reported interest in using the
portal after viewing a prototype. Major perceived barriers included security
concerns, lack of technical skills/interest, and preference for in-person
communication. Facilitators to portal use included convenience, health
monitoring, and improvements in patient-provider communication. Participants
with limited health literacy discussed more fundamental barriers to portal use,
including challenges with reading and typing, personal experience with online
security breaches/viruses, and distrust of potential security measures.
Caregivers expressed high interest in portal use to support their roles in
interpreting health information, advocating for quality care, and managing
health behaviors and medical care.
Conclusions
Despite concerns about
security, difficulty understanding medical information, and satisfaction with
current communication processes, respondents generally expressed enthusiasm
about portal use. Our findings suggest a strong need for training and support
to assist vulnerable patients with portal registration and use, particularly
those with limited health literacy. Efforts to encourage portal use among
vulnerable patients should directly address health literacy and
security/privacy issues and support access for caregivers.
Full article at: http://goo.gl/60yyps
By: Lina Tieu, MPH,
1 Urmimala Sarkar, MD, MPH,1 Dean Schillinger, MD,1 James D Ralston, MD, MPH,2 Neda Ratanawongsa, MD, MHS,1 Rena Pasick, DrPH,3 and Courtney R Lyles, PhD1
1Division of General Internal Medicine,
University of California, San Francisco, San Francisco, CA, United States
2Group Health Research Institute, Seattle,
WA, United States
3Helen Diller Family Comprehensive Cancer
Center, University of California, San Francisco, San Francisco, CA, United
States
Lina Tieu, Division of General Internal
Medicine, University of California, San Francisco, DGIM at SFGH, Box 1364, 1001
Potrero Ave, Bldg 10, Ward 13, San Francisco, CA, 94143, United States, Phone:
1 415 206 7878, Fax: 1 415 206 7880, Email: ude.fscu@ueiT.aniL.
J Med Internet Res. 2015 Dec; 17(12): e275.
More at: https://twitter.com/hiv insight
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