Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Mar 29, 2022)
Date Submitted: Jul 28, 2021
Open Peer Review Period: Jul 28, 2021 - Aug 5, 2021
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Patient portal mobile app adoption and use: A pooled cross-sectional study from a national survey
ABSTRACT
Background:
While overall portal adoption has steadily increased over time, a digital divide has persisted, suggesting new implementation strategies may be needed. The 21st Century Cures Act has expanded patients’ access to portals through mobile applications (apps). To date, there have been limited studies examining adoption and use of patient portal mobile apps, especially on a national scale.
Objective:
This study has two objectives: 1) to assess which patients are most likely to use patient portal mobile apps, and 2) to assess whether patient portal mobile app use is associated with patient portal feature use (i.e., secure messaging, downloading medical records, viewing test results) in a national survey of U.S. adults.
Methods:
Using the 2019 and 2020 Health Information National Trends Survey, we examined whether patient portal adopters accessed their portal through a mobile app compared to website-only access. Multivariable logistic regression models were conducted to assess factors associated with mobile app adoption and whether mobile app adoption was associated with patient portal feature use, controlling for digital access (e.g., device ownership), demographic factors, health status, and social determinants of health.
Results:
The final sample consisted of 2,771 respondents, who had reported patient portal use in the last year, where 962 (34.7%) were classified as mobile portal app users and 1,809 (65.3%) were classified as non-users. In the multivariable analyses, factors significantly associated with greater odds of mobile portal app use included being a portal super-user (OR: 1.90, 95% CI: 1.35 - 2.66), owning a smartphone (OR: 2.35, 95% CI: 1.19 - 4.63), and owning a Fitbit (OR: 1.49; 95% CI: 1.08 - 2.06). In contrast, age over 65 was associated with significantly lower odds of mobile portal app use. Controlling for other factors, mobile portal app use was associated with significantly higher odds of secure messaging (OR: 1.58, 95% CI 1.13 - 2.22), using the portal to download medical records (OR: 2.33, 95% CI: 1.59 - 3.43), and viewing test results in the portal (OR: 1.95, 95% CI: 1.11 - 3.43). Other factors, such as lower educational attainment and lack of a usual source of care, were negatively associated with patient portal feature use.
Conclusions:
Patient portal mobile app access may improve overall portal adoption and use. Optimizing the implementation and delivery of patient portal content via mobile apps may be one modifiable area that healthcare organizations can use to improve their reach to patients, including those who previously were not able to access the portal due to home internet constraints. While we did not observe socioeconomic disparities in portal mobile app adoption, we did observe these disparities in feature use. Additional implementation strategies (e.g., patient education) are likely needed to overcome persistent socioeconomic disparities in patient portal use. Clinical Trial: Not applicable
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