Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study.

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  • Additional Information
    • Author-Supplied Keywords:
      cohort studies
      patient portals
      pregnancy
      socioeconomic factors
    • Abstract:
      Background: Electronic patient portals are websites that provide individuals access to their personal health records and allow them to engage through a secure Web-based platform. These portals are becoming increasingly popular in contemporary health care systems. Patient portal use has been found to be beneficial in multiple specialties, especially in the management of chronic disease. However, disparities have been identified in portal use in which racial and ethnic minorities and individuals with lower socioeconomic status have been shown to be less likely to enroll and use patient portals than non-Hispanic white persons and individuals with higher socioeconomic status. Electronic patient portal use by childbearing women has not been well studied, and data on portal use during pregnancy are limited.Objective: This study aimed to quantify the use of an electronic patient portal during pregnancy and examine whether disparities related to patients' demographics or clinical characteristics exist.Methods: This was a retrospective cohort study of women who received prenatal care at an academic medical center from 2014 to 2016. Clinical records were reviewed for portal use and patient data. Patients were considered enrolled in the portal if they had an account at the time of delivery, and enrollees were compared with nonenrollees. Enrollees were further categorized based on the number of secure messages sent during pregnancy as active (≥1) or inactive (0) users. Bivariable chi-square and multivariable Poisson regression models were used to calculate the incidence rate ratio of portal enrollment and, if enrolled, of active use based on patients' characteristics.Results: Of the 3450 women eligible for inclusion, 2530 (73.33%) enrolled in the portal. Of these enrollees, 72.09% (1824/2530) were active users. There was no difference in portal enrollment by maternal race and ethnicity on multivariable models. Women with public insurance (adjusted incidence rate ratio; aIRR 0.60, 95% CI 0.49-0.84), late enrollment in prenatal care (aIRR 0.78, 95% CI 0.69-0.89 for second trimester and aIRR 0.50, 95% CI 0.39-0.64 for third trimester), and high-risk pregnancies (aIRR 0.82, 95% CI 0.75-0.89) were significantly less likely to enroll. Conversely, nulliparity (aIRR 1.10, 95% CI 1.02-1.20) and having more than 8 prescription medications at prenatal care initiation (aIRR 1.19, 95% CI 1.06-1.32) were associated with greater likelihood of enrollment. Among portal enrollees, the only factor significantly associated with active portal use (ie, secure messaging) was nulliparity (aIRR 1.11, 95% CI 1.01-1.23).Conclusions: Among an obstetric population, multiple clinical and socioeconomic factors were associated with electronic portal enrollment, but not subsequent active use. As portals become more integrated as tools to promote health, efforts should be made to ensure that already vulnerable populations are not further disadvantaged with regard to electronic-based care. [ABSTRACT FROM AUTHOR]
    • :
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    • Author Affiliations:
      1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States
      2Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
      3Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
    • Full Text Word Count:
      5684
    • ISSN:
      1438-8871
    • Accession Number:
      10.2196/14445
    • Accession Number:
      138942456
  • Citations
    • ABNT:
      UKOHA, E. P.; FEINGLASS, J.; YEE, L. M. Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study. Journal of Medical Internet Research, [s. l.], v. 21, n. 9, p. N.PAG, 2019. DOI 10.2196/14445. Disponível em: http://widgets.ebscohost.com/prod/customlink/proxify/proxify.php?count=1&encode=0&proxy=&find_1=&replace_1=&target=http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lxh&AN=138942456&authtype=sso&custid=s5834912. Acesso em: 29 jan. 2020.
    • AMA:
      Ukoha EP, Feinglass J, Yee LM. Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study. Journal of Medical Internet Research. 2019;21(9):N.PAG. doi:10.2196/14445.
    • APA:
      Ukoha, E. P., Feinglass, J., & Yee, L. M. (2019). Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study. Journal of Medical Internet Research, 21(9), N.PAG. https://doi.org/10.2196/14445
    • Chicago/Turabian: Author-Date:
      Ukoha, Erinma P, Joe Feinglass, and Lynn M Yee. 2019. “Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study.” Journal of Medical Internet Research 21 (9): N.PAG. doi:10.2196/14445.
    • Harvard:
      Ukoha, E. P., Feinglass, J. and Yee, L. M. (2019) ‘Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study’, Journal of Medical Internet Research, 21(9), p. N.PAG. doi: 10.2196/14445.
    • Harvard: Australian:
      Ukoha, EP, Feinglass, J & Yee, LM 2019, ‘Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study’, Journal of Medical Internet Research, vol. 21, no. 9, p. N.PAG, viewed 29 January 2020, .
    • MLA:
      Ukoha, Erinma P., et al. “Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study.” Journal of Medical Internet Research, vol. 21, no. 9, Sept. 2019, p. N.PAG. EBSCOhost, doi:10.2196/14445.
    • Chicago/Turabian: Humanities:
      Ukoha, Erinma P, Joe Feinglass, and Lynn M Yee. “Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study.” Journal of Medical Internet Research 21, no. 9 (September 2019): N.PAG. doi:10.2196/14445.
    • Vancouver/ICMJE:
      Ukoha EP, Feinglass J, Yee LM. Disparities in Electronic Patient Portal Use in Prenatal Care: Retrospective Cohort Study. Journal of Medical Internet Research [Internet]. 2019 Sep [cited 2020 Jan 29];21(9):N.PAG. Available from: http://widgets.ebscohost.com/prod/customlink/proxify/proxify.php?count=1&encode=0&proxy=&find_1=&replace_1=&target=http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lxh&AN=138942456&authtype=sso&custid=s5834912