JMIR Publications

ABSTRACT

Background:

Older people are the highest users of the health service but are less likely to use a patient portal than younger people.

Objective:

The aim of this scoping review was to identify and synthesise the literature on contextual factors that impact the implementation of patient portals in healthcare settings and among older people.

Methods:

A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) guidance. The following databases were searched from 2010 to June 2020: MEDLINE and EMBASE via the OVID platform, CINAHL and PsycInfo via the EBSCO platform, and The Cochrane Library. Eligible reviews were published in English, focused on the implementation of tethered patient portals, included patients, healthcare professionals, managers, and budget holders, and aimed at identifying contextual factors (i.e. barriers and facilitators) that impact the implementation of patient portals. Review titles, abstracts and full-text publications were screened in duplicate. Study characteristics were charted by one author and checked for accuracy by a second author. The Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework was used to synthesise the findings.

Results:

Ten systematic reviews published between 2015 and 2020 were included. Three addressed patient portals in secondary care, five examined patient portals in both secondary care and other care settings, and two addressed the implementation of patient portals with older adults in multiple settings, including secondary care. Contextual factors influencing patient portal implementation tended to cluster in specific NASSS domains: 1) the condition, 2) the technology, and 3) the value proposition. Certain aspects within these domains received more coverage than others, such as sociocultural factors and comorbidities, the usability and functionality aspects of the technology, and the demand-side value. There are gaps in the literature pertinent to a consideration of provision of patient portals for older people in secondary care including: lack of consideration of the diversity of older adults and their needs, the question of interoperability between systems (likely to be important where care involves multiple services), the involvement of lay caregivers and looking beyond short-term implementation to ways in which portal use can be sustained.

Conclusions:

We identified important barriers and facilitators to patient portal implementation and key gaps in the literature. Future research should focus on evaluating interventions to address disparities and promote engagement with patient portals.