JMIR Publications

ABSTRACT

Background:

Patients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these vulnerable patients (i.e. Medicaid recipients, older, and/or Limited English Proficient) in navigating health systems- and provider support of the use of patient portals among these groups may also facilitate caregivers’ use of their patients’ portal.

Objective:

Because safety-net provider work closely with caregivers to care for their patients, we used qualitative methods to explore safety-net providers’ perspectives on portal use among caregivers for their patients— especially since there is limited literature about caregivers’ use of portals in the safety-net.

Methods:

We conducted 45-60 minute semi-structured interviews with providers from three large California safety-net health systems. The interviews focused on providers’ experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. Three coders analyzed the interview transcripts using both deductive and inductive approaches and established consensus regarding major themes.

Results:

Of 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership/administrative role. We describe themes highlighting providers’ recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement. Themes describing benefits included: “Portal positioned to assist caregivers with healthcare tasks,” “Portal as a tool to directly support caregivers,” and “Expanding portal functionality for caregiver use.” Themes describing challenges included: “Barriers to caregiver enrollment and use” and “Privacy and security in the caregiver-provider-patient triad.”

Conclusions:

Providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety-net. Providers in safety-net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings, and may pose challenges to portal adoption. They noted that caregivers of patients in the safety-net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers’ interest and ability to access portals across barriers in health/digital literacy and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security.