JMIR Publications

ABSTRACT

Background:

Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal utilization and their association with patient engagement among patients with multimorbidity in rural communities is limited.

Objective:

To explore the factors associated with portal utilization by rural patients according to multimorbidity, demographic, and socioeconomic characteristics.

Methods:

We assessed patient portal utilization among patients with one or more chronic diagnoses who sent or received messages via the Epic MyChart portal between January 1st, 2015, and November 9th, 2021. Patient portal utilization was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient’s number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient’s home address, were also included in the model to assess the influence of community factors on portal utilization. County-level factors include educational attainment, smartphone ownership, median income, and primary care provider density.

Results:

A total of 65,178 patients were included in the final dataset, of which 38,380 (58.9%) sent at least one message via the portal during the 7-year study period. We found that as the number of chronic diagnoses increased, so did patient portal utilization, however, this relationship was driven primarily by younger patients. Patients with two chronic conditions were 1.57 times more likely to send messages via the portal than those with a single chronic condition. In comparison, patients with seven or more chronic conditions were nearly 11 times more likely to send messages via the portal than patients with a single condition. Other significant factors associated with increased portal utilization include being female, white, younger, married, with private insurance, and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income.

Conclusions:

Patients use of the portal to send messages to providers was incrementally related to their number of diagnoses. We found that as the number of chronic diagnoses increased, so did portal utilization. Healthcare systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity.