JMIR Publications

ABSTRACT

Background:

Electronic patient portals are websites that provide individuals access to their personal health records and allow them to engage through a secure online platform. These portals are becoming increasingly popular in contemporary healthcare systems. Patient portal use has been found to be beneficial in multiple specialties, especially in management of chronic disease. However, disparities have been identified in portal use in which racial/ethnic minorities and individuals from lower socioeconomic status have been shown to be less likely to enroll and use patient portals than non-Hispanic white persons and persons 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:

The objective of this study was to quantify use of an electronic patient portal during pregnancy and examine whether disparities exist related to patient demographics or clinical characteristics.

Methods:

Retrospective cohort study of women who received prenatal care at an academic medical center (2014-16). 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; enrollees were compared to non-enrollees. Enrollees were further categorized based on the number of secure messages sent during pregnancy as active (≥1) versus 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 patient characteristics.

Results:

Of 3450 women eligible for inclusion, 2530 (73%) enrolled in the portal. Of these enrollees, 1824 (72%) 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% confidence interval [CI] 0.49 to 0.84), late enrollment in prenatal care (aIRR 0.78; 95% CI 0.69 to 0.89 for 2nd trimester and aIRR 0.50; 95% CI 0.39 to 0.64 for 3rd trimester), and high-risk pregnancy (aIRR 0.82; 95% CI 0.75 to 0.89) were significantly less likely to enroll. Conversely, nulliparity (aIRR 1.10; 95% CI 1.02-1.20) and having more than eight 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 (i.e. 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.